adminCatherine Murombedzi
The world has to combat multi drug resistance TB (MDR-TB) if the end of this disease by 2030 is going to be a reality.
The approach of business as usual has to end as this calls for unusual approach if we are to meet the SDGs and end TB by the set target date as not doing so will see TB being a burden.
First how does resistance build-up? A close look to this is simple. Resistance comes from ineffective treatment regimens, poor quality medicines and at times even falsified drugs.
Correct storage also plays a role as drugs can degenerate even before expiry date and giving these drugs out to patients would be futile.
Health personnel ought to be adequately trained to handle TB cases. They in turn have to educate the patient on the need to complete treatment. TB unlike a headache where one stops taking pain killers when feeling better is not to be taken in the same approach. If a doctor prescribed treatment for 6 months or even a year then that has to be completed even when one feels okay after three months.
MDR-TB does not respond to isoniazid and rifampicin which are two key TB drugs used in standard first line treatment.
Statistics given out by Dr Mario Raviglione, Director of WHO Global TB Programme during a webnar leading to World TB Day said that global burden of multi drug resistance TB was on the increase.
“MDR-TB accounted for 480 000 cases in 2014 and this was 3% of new TB cases globally. A total 190 000 deaths were recorded,” said Dr Raviglione.
An estimated 9.7% of these MDR-TB cases are extensively drug resistant TB (XDR-TB) which has been reported in 105 countries so far. Our neighbouring country South Africa reported XDR-TB in 2011 and with unemployment high in Zimbabwe above 80% the working class has trekked to South Africa in search of employment.
TB knowing no borders Zimbabwe has to treat MDR-TB cases with the serious concern it deserves.
Director for HIV/AIDS and TB in the Ministry of Health and Child Care Dr Owen Mugurungi said decentralisation of TB treatment would decongest the main centres.
“Decentralisation of MDR-TB treatment in the country will decongest the burden at Wilkins Infectious Diseases, Nazareth and Thorngrove hospitals,” said Dr Mugurungi.
Dr Mugurungi spoke on the need to further train nurses in handling TB cases.
“What we need to do is to equip the existing nursing staff with skills and knowledge on how to treat MDR-TB,” Dr Mugurungi said.
Mission hospitals like Murambinda in Buhera, Howard Hospital in Chiweshe and Karanda Hospital in Mt Darwin are fully equipped to handle MDR-TB cases.
When a patient fails to respond to first line regimens then more efficacious treatment is used and this is second line treatment.
Second line treatment has severe side effects. Gatro-intestinal disturbances, psychotic disorders, ototoxicity which may lead to deafness for life.
In Zimbabwe cases of MDR tuberculosis reported in 2015 showed a rise in the number of infections at 120. Nationally in 2011 there were five cases of MDR-TB that were reported. The rise to +120 can be argued that it is not a true reflection of the increase of MDRTB because GeneXpert machine was not widely available, so detection of MDR-TB was limited then but is now possible using the GeneXpert because the machine is now available in ten provincial hospitals. Four years ago the gadget was only found then at Murambinda Mission Hospital run by catholic sisters in conjunction with MSF.
Health personnel in district hospitals seem not prepared and equipped to handle MDR-TB patients. A case in point is that at Karoi District Hospital where such patients are housed in a wooden hostel and have to use outside amenities for ablution. The nurses are afraid to handle the patients and neglect was noted by a health monitoring team that visited the hospital in 2013.
Mr Stanley Takaona who headed the team noted the poor and lack of support for MDR-TB patients at Karoi Hospital.
“On our visit to Karoi District Hospital we sadly noted three patients who were housed in a wooden house and had to use outside toilets and bathroom. The nursing staff showed fear of contracting the MDRTB hence they did not handle the patients correctly,” said Mr Takaona.
Most hospitals in Zimbabwe refer MDR-TB patients to access treatment from home and for some patients the distances they have to travel on foot is 5km and above hence they fail to adhere. Accessing treatment from home poses a further threat as spread to family members is exposed.
World experts are not sleeping on their laurels as far as MDR-TB is concerned.
The Union, US Agency for International Development, Janssen Research & Development, UK Medical Research are collaborating on an on-going clinical trial called STREAM. This is focusing on shortening treatment regimens for MDR-TB. If successful, the new regimens could shorten treatment time from 2 years to 6 to 9 months. It will be patient friendly as it would be oral medication removing the need for painful daily injections. MSF is calling for affordable medicines to treat TB by repealing the TRIPS. They are therefore lobbying for more use of generic medicine which has saved millions of lives. Generic medicine has saved lives of millions in the developing world hence Indian pharmacies are dubbed third world pharmacies.
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