Early TB testing is vital to saving lives

Pretty Chavango, CNS Correspondent, Zimbabwe
Photo credit: CNS: citizen-news.org
According to the WHO Global Tuberculosis report 2014, TB remains one of the world’s deadliest communicable diseases, with an estimated 9.0 million people developing TB and 1.5 million dying from it in 2013. Also, an estimated 480 000 people developed multi drug resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB)  in 2013. If all notified TB patients (6.1 million) had been tested for drug resistance in 2013, an estimated 300,000 cases of MDR-TB would have been detected.

Early and improved case detection of TB, including MDR-TB and XDR-TB, has therefore become one of the global priorities for TB control. Not only are these strains more difficult and extremely expensive to treat but their cure success rate is also comparatively lower than that for drug susceptible TB. Furthermore, drug-resistance in TB is particularly concerning for patients with already-compromised immune systems, especially those with HIV.

The WHO Global TB Report 2014 lists five priority actions to address the MDR-TB epidemic:(i) High quality treatment of drug susceptible TB; (ii) Expansion of rapid testing and detection of MDR-TB cases; (iii) Immediate access to quality care; (iv) Infection control; and (v) Increased political commitment.

Zimbabwe’s economy is mainly hinged on agriculture, Once the bread basket of Africa , the recent economic meltdown has seen most farmers move from grain production to tobacco-- the cash crop that has become the means of survival for most rural and urban farmers. Zimbabwe faces the dilemma of supporting tobacco farming--the backbone of its economy-- whilst at the same time supporting the healthy cause of anti–tobacco lobbying. Tobacco use has contributed to increase in cases of TB in Zimbabwe.

Minister of Health and Child Welfare, David Parirenyatwa  said that while tobacco was a major revenue generating activity for Zimbabwe, from a health perspective its use can kill. Studies have shown the harmful links between tobacco and developing TB. Regular smoking of tobacco doubles the risk of people who had been previously diagnosed with TB to face a recurrence. Zimbabwe is a high TB burden country. In 2013, incidence of TB was 78,000. %age of TB cases with MDR-TB was 1.9% in new and 8.3% in retreatment cases.

Adding fuel to fire, health services in Zimbabwe are deteriorating with most public health institutions being under stocked, a lot of brain drain has occurred with health care givers migrating to other countries. As a result, it takes a long time for TB patients to get tested correctly for TB and be given inappropriate treatment meanwhile. All this prolongs suffering and morbidity; enhances the severity of the disease, making it more difficult to treat when eventually detected, and amplifies resistance. Treatment interruption causes transmission to others even as health deterioration continues. Most of these conditions are avoidable if correct diagnosis for MDR-TB is made early and appropriate treatment given.

During a media webinar (organized by CNS and the Union), ‘Is detecting drug resistance at the time of TB diagnosis important?’ Dr Sarabjit Chadha, Project Director, International Union Against TB and Lung Disease, said that a delay in diagnosis of drug resistance can result in dire consequences as many patients will not survive the delay and the inappropriate treatment given to them (in the absence of confirmed diagnosis of MDR-TB) especially if there are co-morbidities like HIV or diabetes.

Ministry of Health and Childcare Deputy Director for the AIDS and TB unit in Zimbabwe, Dr Charles Sandy says that the best way of avoiding MDR-TB is by adhering to the treatment prescribed by the TB specialist. But in case a person does contract MDR-TB, early diagnosis and proper treatment can go a long way in curing the patient and in preventing the spread of infection. This is perhaps one of the main reasons for Zimbabwe to have introduced the molecular diagnostic tool XpertMTB/RIF at 58 sites. This machine not only gives the test results for TB in 2 hours but also diagnoses resistance for rifampicin—one of the main drugs used for treating ordinary TB.

Commenting during the webinar, global health commentator & Managing Director, Inis Communication, Dr Tim France urged people to test early for TB as it goes a long way in preventing cases of MDR-TB as there will be early treatment. “Ending TB is possible only when we diagnose TB early; characterize the nature, and in particular, the drug-sensitivity of each case; then treat the person with drugs that are most likely to work,” he said.

Pretty Chavango, Citizen News Service - CNS
24 July 2015