Tuberculosis

Zambia commemorates World TB Day

Times of Zambia- March 2008
By DOREEN NAWA
ZAMBIA this week joined the rest of the world in commemorating the World Tuberclosis (TB) Day amid challenges on how to contain the disease.
Zambia like any other southern African country is “struggling to contain” the spread of tuberculosis in the face of the increased cases of the HIV/AIDS epidemic.
Tuberculosis is back with a new face of the combination of the HIV epidemic with new strains of the disease that are resistant to the existing drugs has seen new TB cases and TB-related deaths in the last decade.
Mycobacterium TB, the bacterium that causes the disease, is ancient. But powerful antibiotics brought it under control in the developed world, scientists largely abandoned efforts to develop new drugs or diagnostics, donors stopped funding TB programmes and the global health community shifted its attention elsewhere.
Tuberculosis affects predominantly young, economically active, adults, on whom the development of the poorest countries like Zambia depends.
The world over, and sub-Saharan Africa in particular, is now paying the price. Very few countries in Africa have the technology to test for drug-resistant TB. Without sophisticated laboratory facilities, TB patients co-infected with HIV also present a diagnostic challenge.
TB control efforts have been hampered by the escalating HIV/AIDS epidemic to an extent that TB has now been declared an emergency on the African continent.
The majority of the 20 countries with the highest TB rates are in sub-Saharan Africa. The increasing occurrence of multiple drug resistant TB and HIV is likely to further worsen both HIV and TB treatment efforts.
According to the World Health Organisation (WHO) report issued recently warns that drug-resistant tuberculosis is spreading even faster than medical experts had feared.
With growing numbers of drug-resistant TB patients, there is concern some national health systems will soon be overwhelmed.
Experts say new drugs are needed if the outbreak is to be curbed, along with new diagnostic tests to identify drug-resistant TB strains faster and current tests take about a month for results.
In Zambia currently, lack of access to health services in remote, rural areas adds to the likelihood that large numbers of TB infections are going undetected and untreated, including cases of multidrug-resistant (MDR) and extremely drug-resistant (XDR) tuberculosis.
The overcrowding in most remote areas and other cities like the mining towns in Zambia create the perfect breeding ground for MDR-TB, there is some capacity to diagnose drug-resistant strains, but getting treatment from public health services is another hassle as most of these public health centres are not nearer to the people.
Multi-drug-resistant tuberculosis is a form of tuberculosis that is resistant to two or more of the primary drugs used for the treatment of tuberculosis.
Only a handful of patients access the drugs, which sometimes is again a risk because of lack of consistent to treatment for standard TB treatment.
Countries like South Africa, with superior resources and laboratory capacity, is better positioned than most African countries to detect and manage the new, more dangerous forms of TB.
But experts say the country’s TB control programmes have failed to adapt to the new threats of drug-resistance and HIV co-infection.
Some have blamed South Africa’s dismal TB cure rates on poor implementation of the WHO-recommended Directly Observed Short-Course Treatment (DOTS) for TB; others have called for a new, more patient-centered approach drawing on the strategies used for AIDS treatment.
With the outbreak of virtually untreatable XDR-TB in most southern African countries in 2006 the debate has widened to include the issue of infection control at health facilities, and the potential need for forced hospitalization and treatment of infected individuals.
This has since fueled concerted efforts from various organisations that are working to find a lasting solution to this disease in Africa.
Recently Global Fund to Fight AIDS, TB and Malaria’s chairperson, Rajat Gupta, disclosed the organisation hoped to raise over $12 billion by 2012 to help some of the world’s poorest nations fight the diseases.
Sixty eight per cent of all people infected with HIV live in sub-Saharan Africa, where more than three quarters of all AIDS-related deaths in 2007 occurred.
During his visit to Zambia and other southern African countries, Mr Gupta expressed confidence that the fund could raise the money after it secured $100 million in the past 18 months.
Recent data from Central Statistic Office show that about one million Zambians out of the 12 million are HIV positive and about 300,000 are in need of anti-retroviral therapy with more than half being TB infected.
“The money we are mobilising will help us mitigate the effects of AIDS, tuberculosis and malaria especially in the worst affected countries,” says Mr Gupta.
Briefing Mr Gupta, President Mwanawasa said the country was making progress in the fight against AIDS but says the 16 per cent HIV/AIDS prevalence rate was still high.
“The HIV prevalence rate in Zambia is unacceptably high and continues to be a source of concern to this nation. The AIDS situation in Zambia is further compounded by co-epidemics of tuberculosis and malaria,” says Dr Mwanawasa.
Talk of quarantine could add to the stigma that already prevents many people from seeking TB treatment.
Already the strong association between TB and HIV means that people suffering TB symptoms often prefer not to seek treatment rather than face the possibility of being HIV-infected.
Mr Gupta further notes that TB has always affected the most marginalised groups of society, which may explain why the disease has fallen off the public agenda.
“This disease has taken a new dimension in Zambia and Africa as a whole because of the increased cases the HIV/AIDS epidemic,” Mr Gupta says.
World TB Day on Monday March 24 was an opportunity for activists, health practitioners and journalists to push for a greater sense of urgency in TB responses, particularly in the context of southern Africa’s already crushing HIV burden.
TB is a contagious disease spread through the air. One third of the world’s population is believed by the WHO to be infected, but the disease lies dormant in most people until their immune system is weakened.
The co-infection of HIV and TB is one of the principal causes of the disease’s spread in Zambia.
Both the highest number of deaths and the highest mortality per capita are in Africa. Africa has the highest incidence of Tuberculosis rate per capita (363 per 100 000 population).
According to a new report by the World Health Organisation (WHO), there were about 14.4 million cases of TB in 2006 and an estimated 0.5 million cases of multi drug-resistant TB (MDR-TB) in 2006.
Targets for global TB control have been set within the framework of the Millennium Development Goals (MDGs).
The MDG Six target is to halt and reverse TB incidence by 2015. The Stop TB Partnership has set two additional impact targets: To halve prevalence and death rates by 2015 compared with their level in 1990.
The incidence of tuberculosis in Zambia is on the rise, with new infections fueled by a 70 per cent HIV co-infection rate. USAID helps the ministry of Health strengthen Zambia’s capacity to deliver proven, cost-effective interventions.
USAID’s partners work in three provinces to expand and enhance Directly Observed Treatment Short-course (DOTS) and improve the co-management of tuberculosis and HIV/AIDS.
A complete package of measures is needed that takes into account the changes in the epidemiology of TB and that harnesses the community capacity that has arisen in most cities with a high prevalence of HIV.
Such a package would reduce transmission of tuberculosis by improving case finding and treatment, reduce reactivation of tuberculosis by establishing preventive therapy services and reduce transmission of HIV by enhancing voluntary HIV counselling and testing (VCT) services.
Encouraging people to go for VCT would be an entry point to integrate the management and prevention of HIV-related TB.
When all efforts are put together, the success will be measured by the impact on the community’s burden of TB and other HIV related illness.
Economic and social science evaluations will determine the potential cost-effectiveness and sustainability of the package.
Process indicators of demand for and acceptability of the package, equity of access to the services provided and cohort analysis of those treated for tuberculosis or with preventive therapy will also measure success.