Drug Adherence Leads To Successful TB Treatment

Photo credit: Owen Nyaka
Owen Nyaka, CNS Correspondent, Malawi
“God is mysterious. I was nearly incapacitated by the TB infection since I could not do anything apart from sleeping in agony every day at home, my children were greatly affected by my illness because am the bread winner. My life is now back to normal,” says Eveless.

On a hot late morning, wearing a white T-shirt labelled ‘Stop TB’ , 52 year old widow Eveless,  who is a cured TB survivor, narrated her story of how she fought TB fourteen years ago. Eveless is Vice Chairperson of Tikondane Anti-TB Club and is also a member of an HIV support group. She lives in an informal settlement of Vivi-Chizeze, traditional authority Chimutu in Lilongwe. Her three children are now 31, 29 and 27 years old.

Her husband passed away in 1997 after a short illness. He was the only bread winner in the family. After his death, Eveless decided to start a small scale business as a tomato seller in the nearby market at Chiwamba trading centre. She managed to survive with the income generated from this small business and could send her 3 children to school and look after their basic needs. Then suddenly her life was hit by a severe blow.

“I could not figure out what was happening as I could not understand what was really causing my deteriorating health condition. I used to get sick very often and clinicians mostly diagnosed me with malaria but the prescribed medicines were not effective. I started experiencing persistent headache, cough, backaches and pneumonia on a regular basis,” said Eveless.

Sometimes she would sweat at night even in cold weather. Her relatives and neighbours thought that she was bewitched and took her to a traditional healer. But her health continued to worsen. She was then taken to Chiwamba health centre where medical personnel referred her to Bottom hospital (now Bwaila hospital) in Lilongwe for further examination.

“I went to Bwaila Hospital in early 2000 where my sputum was taken for examination, and shockingly I was diagnosed with TB. I was immediately given a two weeks TB drug starter pack as a first line treatment which helps to stabilize TB patients. I was advised to go with a guardian who could help in collecting medicine and provide drug adherence guidelines and counselling after the starter pack, ” says Eveless.

After two weeks, upon completing the starter pack, Eveless was enrolled on an eight months’ treatment regimen and was advised to take it consistently without missing a dose. With assistance from her guardian, she diligently complied and followed the treatment plan as directed by health personnel. However, there was a time when she nearly thought of stopping the medication because of side effects.

“It was so terrible that I wanted to stop treatment after noticing that the TB medicines affected my body. Even the colour of urine changed as well as the colour of my eyes,” she recalls. She also started experiencing strange and terrifying dreams, but she persisted and continued to take the TB medication and successfully completed treatment until the health personnel confirmed that the TB infection had been successfully treated.

“Many people still think that there is no treatment for TB, but that is not true. What you need to do is to stop drinking beer, avoid sexual contact and follow medical advice. Many people in my community like going to traditional healers when they are ill, but this is dangerous. The problem is that traditional healers cannot diagnose and treat TB-- it is only the hospitals that can do this,” says Eveless.

Eveless is back to her business. But her immediate need is to get fertilisers at subsidised rates to manage her sizeable maize garden that will eventually equip her with adequate food as well as become a long term sustainable income generation tool. However, governments and policymakers are failing to involve communities in HIV and TB control programmes, and just focussing on experts to make key decisions. This issue has triggered debate at the 20th AIDS 2014 conference in Melbourne, Australia (20 – 25 July) as representatives of some African communities claim they are being locked out of the TB-HIV response.

When asked what needs to be done for TB and HIV collaborative action in the 22 high burden countries in order to reduce TB related deaths in people living with HIV and what have been the major learning’s, Dr. Riitta Dlodlo, TB-HIV Programme Coordinator at the International Union Against Tuberculosis and Lung Disease, (the Union)  says that, “We need to continue keeping TB-HIV issues on the agenda. There are many reasons why patients with these two conditions may die. They range from late presentation to care, (frequently due to limited access to care, poverty, stigma) to delays in diagnosis and initiation of life saving treatments.”

“I feel we need wide actions, such as increasing community awareness of TB and HIV association, HIV care and ART that are currently widely available and how people could seek help,” says Dr. Dlodlo.

Dr Dlodlo feels that health workers need training, support supervision and clinical mentoring to perform better. In addition to knowledge-related issues, health workers should also make their attitudes more patient-centered. They need communication skills to create good rapport with patients, their families and communities at large.

“As you know, TB drug-resistance is a man-made issue and reflects ‘floppy’ performance of TB treatment services of drug-sensitive TB. The key step in preventing further spread of MDR-TB is to ‘close the tap’. It is also important to expand access to rapid and affordable diagnosis of MDR-TB and access quality assured second line TB medicine,” says Dr. Dlodlo.

Dr. Anthony D Harries, Senior Advisor at the Union also shared his sentiments saying that, “Good infection control practices in health facilities and the community, earlier diagnosis of MDR-TB in patients who are failing first line treatment and shorter and less toxic anti-TB treatment regimens that can help patients to properly complete treatment are some of the impediments which high burden countries are facing to stem the increasing incidence of MDR-TB.”

He also said better control of HIV and instituting widespread ART will be crucial to reduce the risk of TB in high HIV-prevalence areas.

Owen Nyaka, Citizen News Service - CNS
25 July 2014