Handling TB beyond 2015

Catherine Mwauyakufa, CNS Correspondent, Zimbabwe
Photo credit: CNS: citizen-news.org
In Zimbabwe the majority of hospital admissions are due to lung diseases. A large proportion of them (around 60%) have a compromised immunity system together with TB. Lung diseases are treated with concern and there are follow-up mechanisms from the health care providers if one is diagnosed with TB. TB management is done at public health care institutions free of cost and even patients from the private doctors and private health care facilities are referred to government hospitals for proper care.

The main drugs- rifampicin and isonizad- together with a host of other drugs are in use. However, there are cases when these fail and there is need to use more efficacious drugs.

In the 90s World Health Organisation (WHO) declared TB an emergency and Zimbabwe too had treated it so. Over the years, with many TB patients presenting themselves with HIV co-infection, at health institutions locally, the strain has been felt as the country has had a brain drain with qualified health personnel, nurses, doctors, laboratory technicians and pharmacists seeking greener pastures abroad, leaving newly qualified staff to fill in the gap. To top it all, patinets with TB-HIV coinfection have further increased the strain on the health care systems. In the 90s anyone suffering from TB had home visits from the nearest health facility and was monitored for taking daily doses. This is no longer possible given the economic challenges the country is facing.

The National Aids Council was founded in 1999 and by 2000 the organisation was working at national level. The then President of Zimbabwe, His Excellency President Mugabe, had declared HIV a national emergency, and it still is. There has been an improved service delivery but the country is far from being comfortable.

When one is diagnosed with TB, daily treatment is started. Monitoring of the client is also done as they keep track of the patient. If one is also infected with HIV then counseling is commenced before putting one on anti retroviral therapy (ART). ART retention and quality care is offered but at times the specialized service that is needed is found lacking.

Dr Owen Mugurungi, National Director in the AIDS and TB unit in the Ministry of Health and Childcare, while speaking to journalists in Kadoma last year, had said that,“The diagnosis, treatment, care and follow-up procedure is of great concern to the Health Ministry. Any leakages will be costly so we treat TB with the care it deserves.”

In Zimbabwe 95% to 97% of TB patients know their HIV status. Data collected by the National Aids Council in 2014 showed that 69% of TB patients were HIV positive.The country’s ART coverage has improved over the years as seen by more people being registered. This is an important aspect as there is a co-relation between TB and HIV.

“In 2010 ART coverage was at 44% and a year later rose to 60%. In 2012 it further improved and 70% patients got anti retroviral therapy. In 2013 the country got to universal coverage and had 80% patients in need of ART now covered,” Dr Mugurungi said.

Paediatric TB is still a challenge as TB diagnosis in children is still difficult. This has led to poor attention and with fatalities at times.“National paediatric ART is at 46% and the country needs to scale this up if we are to get children on an equal footing with adults,” said Dr Mugurungi.“In the coming years we intend to get paediatric ART over 70%,” he said.

“HIV positive patients with chronic cough are offered TB screening. All TB and HIV co-infected patients get cotrimoxazole and ARVs. We are training health personnel in TB/HIV management. We also are strengthening the daily observed treatment scheme,” said Dr Mugurungi.

Stigma still impacts negatively on TB screening, as patients often report late and are then found to be co-infected. The future lies in children and this generation needs to get full medical attention if the spread of lung diseases like TB is to be combated beyond 2015.

Catherine Mwauyakufa, Citizen News Service - CNS
August 21, 2015