Kenya has done it, when will the rest of us?

Shobha Shukla - CNS (Citizen News Service)
Dr Immaculate Kathure, Child TB Services
Coordinator, Kenya National TB Programme
Yes, this question merits serious thought, even as Kenya Ministry of Health recently announced the launch of fixed dose combination (FDC) of first-ever child-friendly TB medicines, making Kenya the first country in the world to roll out these products nationally. Starting 1st of October 2016, all children in Kenya, who will be initiated on TB treatment, will be given the improved formulation that is easier for caregivers to give and for children to take, and is expected to help improve treatment outcomes of childhood TB.

It was on 2nd December, 2015, just ahead of 46th Union World Conference on Lung Health in Cape Town, South Africa, that the world's first appropriate, child-friendly FDC medicines to treat children suffering from drug-sensitive TB were launched, thanks to the untiring efforts of TB Alliance and its partners: WHO, UNITAID and USAID.

During the launch almost 10 months back, Dr Enos Masini, Kenya's National Tuberculosis Programme manager, had said, "Childhood TB is a problem that can be solved when we choose to act. We need to make sure all children with TB are diagnosed and treated with the best medicines possible. I am proud to say Kenya plans to adopt these new products for our children immediately, which will greatly improve our response to treating drug-sensitive TB."

Well, exactly 10 months down the line, Kenya has honoured its promise. What about the rest of the world? How long will other countries take to introduce the new improved paediatric TB medicines?

Citizen News Service (CNS) interviewed (via email) Dr Immaculate Kathure, Child TB Services Coordinator of the Kenya National TB Programme. Here are excerpts from Dr Kathure's interview:

What prompted Kenya to lead introduction of new formulation?

Dr Immaculate Kathure: “The Kenya government’s national TB programme has a commitment to ensure that we reduce the burden of lung disease in Kenya, rendering Kenya free of TB. This is through the provision of people-centric, universally accessible, acceptable and affordable quality services. Childhood TB is one of the key services we focus on, considering the vulnerability of children to TB. The government is also committed to reducing mortality among children and successful treatment of TB is one of the strategies to ensure we realize this goal.

Children with TB and their caregivers have over the years struggled with TB treatment that is complex - they had to split and crush multiple pills to achieve the right dose for children and children had to swallow these water insoluble bitter-tasting pills. Moreover it was difficult to determine whether children were receiving the correct dose of medicines or not. All this made TB treatment ineffective and increased the rates of drug resistant TB in children. We went for the improved medicines to avert this.”

What were the challenges you faced in launching them?

Dr Immaculate Kathure: “We had to deal with the current formulation stocks that were in the country and in the pipeline. The commodity management team accurately forecasted the needed quantities and an appropriate time to roll-out the new medicines without too much wastage. There was also need for massive sensitization of healthcare workers at the various levels and to ensure they were knowledgeable on how to use the new medicines. As the time period for this was short, it was addressed through training of the county health teams who in turn were supported to simultaneously train their healthcare workers. This required a huge resource/investment that were graciously availed by the USAID and the TB Alliance. The sensitization programmes are still on-going.”

How many children with TB will benefit from this programme?

Dr Immaculate Kathure: “Starting from 1st October, 2016 all children with TB, whether in the public or private sector, will receive the improved formulations. Children already on TB treatment using the former formulations prior to 1st October will continue and finish on the old ones. Those starting on treatment from 1st October 2016 onwards will initiate on the new medicines. But there is room for special considerations where necessary. The same policy will apply to those in the private sector. Currently 81% of all children on TB treatment are in the public sector, while the rest are in the private sector. For all children with TB, treatment is given free whether in the public or private sector.”

Will this programme have any additional financial burden on Kenya?

Dr Immaculate Kathure: “The improved formulations will ease, and not add, to the financial burden of the government. This is because the current regimen was a complex one - with need for more storage space, higher transport costs and more costs at portal clearance since the commodities were more. The new formulations were procured using the government of Kenya's funding from WHO’s prequalified supplier - Macleods, (an Indian pharmaceutical company). Further procurement will be supported by the government and by partners. We do not foresee any problems now in the implementation of the programme.”

What needs to be done for better TB control in children? 

Dr Immaculate Kathure: “Now that the child-friendly medicines are here, we need to intensify our efforts to find all children who may be exposed to TB and screen them. Those found to have TB should be promptly started on treatment; while those under 5 years exposed to TB, but without disease, should receive Isoniazid preventive therapy (IPT) to protect them from TB. All caregivers of children with TB need to strictly adhere to the advise of the healthcare workers during diagnosis and treatment. Together we can bring childhood TB from the shadows. Action starts with us!”

What is the message for other governments?

Dr Immaculate Kathure: “It is time for governments to rise to the occasion and avail these child-friendly medicines to ensure that we ease the burden on the family during TB treatment for children. It will also ensure improved adherence to treatment which will go a long way in reducing development of drug resistant TB in children. Ultimately we will realize improved child survival and will be well on our way towards a TB free generation”.

Just to remind ourselves, more than 1 million children get sick with TB every year and 400 children succumb to it every day (140,000 deaths every year). Also a whopping 67% of those who suffer from it are not diagnosed or treated. The new palatable FDCs for paediatric TB, are bound to increase treatment adherence, and hence cure rate.

Said Joanna Breitstein, Senior Director (Communications) at TB Alliance: “These medicines went from development to delivery within three years. Please use your voice and get LOUD on social media to applaud this progress in Kenya. TB is tough on kids, and no child should have to struggle with inferior medicines or die of TB”.

Shobha Shukla - CNS (Citizen News Service)
30 September 2016

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