Early detection of MDR-TB is important

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
Photo credit: CNS
In Zimbabwe, cases of multi drug resistant TB (MDR-TB) have reportedly been on the increase—from 5 cases in 2011 to more than 120 in 2014. It can be argued that this phenomenal increase in the number of MDR-TB cases detected is not a true reflection of the incidence of MDR-TB in the country. It could rather be blamed on the limited diagnosis of the disease in the past, due to poor availability of quality diagnostic tools.

Four years ago, in 2011, the rapid molecular testing device—the GeneXpert machine (that diagnoses both TB and Rifampicin resistance, giving the results in less than 2 hours) —was found only at the Murambinda Mission Hospital run by catholic sisters in conjunction with MSF. But today the gadget is available in ten provincial hospitals. This indicates that earlier, detection of MDR-TB in areas which did not have this device, was difficult and many cases were missed out. But, thankfully, today many provincial and district hospitals have GeneXpert in place, resulting in improved diagnosis of MDR-TB. This could perhaps explain the ‘from 5 to 120’ rise in MDR-TB cases noted nationally between 2011-2014.

It would be very pertinent to mention here a recent multi centric study carried out recently in India to assess the impact of up-front testing by GeneXpert on diagnosis of pulmonary TB and rifampicin-resistant pulmonary TB (MDR-TB). Dr K S Sachdeva Additional Deputy Director General Central TB Division of India and lead author of the study informed that this was a pilot study for upfront testing for all presumptive cases of TB, including those of MDR-TB. The study results showed a 39% increase in bacteriologically confirmed TB cases; a five-fold increase in rifampicin resistant TB case detection; and more

than two fold increase in detection rates in PLHIV and in pediatric population. Thus this robust and evidence based study confirms the importance of GeneXpert in controlling MDR-TB. The main drugs used in TB treatment in Zimbabwe are rifampicin and isonizaid and when these fail to work, patients develop resistance to treatment. TB treatment in Zimbabwe is offered free of charge but, surprisingly, people still report for diagnosis late and at times, when the disease has progressed beyond control.

TB and HIV co-infection is another factor that cannot be ignored in Zimbabwe as 70% of TB patients also test HIV positive. MDR-TB is found mostly in people who have had TB treatment before and are also on anti retroviral therapy. Health personnel in district hospitals seem unprepared and ill-equipped to handle MDR-TB patients. A case in point is the Karoi District Hospital, where MDR-TB patients are housed in a wooden hostel and have to use outside amenities for their daily ablutions. The nurses are generally afraid to handle these patients and utter neglect in their care was seen by a health monitoring team that visited the hospital in 2013.

Mr Stanley Takaona who headed the team noted with concern the lack of basic support for MDR--TB patients at Karoi Hospital. “On our visit to Karoi District Hospital we sadly saw that the three MDR-TB patients there were housed in a wooden house and had to use outside toilets and bathrooms. The nursing staff showed fear of contracting the disease and hence they did not handle the patients properly,” said Mr Takaona.

Mr Takaona however was very appreciative of the manner in which MDR-TB patients were very ably treated in places where MSF (Médecins Sans Frontières or Doctors Without Borders) operated--“We have been to Tsholotsho district and I am pleased to say that MSF has built a half way hospital for MDR-TB patients. The patients are on full treatment and hence pose no threat of further drug resistance. They have decent facilities and the health personnel treat them with care,” said Takaona.

Most hospitals in Zimbabwe prefer that MDR-TB patients seek treatment by staying at home and visiting the hospital for their medication. But some patients may have to travel more than 10km on foot to reach a health facility and hence they fail to adhere to treatment. Accessing treatment from home poses a further threat as it exposes the other family members to infection, increasing their chances of contracting the disease.

MSF is calling for affordable medicines to treat TB. They are therefore lobbying for more use of generic medicine which has saved millions of lives. We can end TB only by diagnosing it early and correctly, then treating the person with appropriate drugs, and all along helping the patient to complete the treatment and not leave it mid way. Then only will the WHO’s End TB Strategy succeed.

Catherine Mwauyakufa, Citizen News Service - CNS 
18 July 2015