Scaling up fight against resistant TB

Saturday March 31 2012

By CHRISTABEL LIGAMI

Twenty one-year-old Millicent Mwangi has been battling multi-drug resistant TB for nearly two years. MDR TB is a lethal infectious strain which is resistant to two of the common or first-line drugs for treating TB — isoniazid (INH) and rifampicin (RMP).

She is among more than 500 patients that have been diagnosed with MDR TB in Kenya alone, 390 of whom are on the government’s free treatment programme at the Kenyatta National Hospital — the country’s largest referral hospital.

Ms Mwangi’s case is unique. It did not develop from normal TB, as happens in the majority of cases.

“I took tests after experiencing severe persistent chest pains,” said Ms Mwangi, who at the time of diagnosis was the youngest MDR TB patient. She was placed on the free treatment therapy at KNH.

The World Health Organisation estimates that one-third of the world’s population is infected with TB, with the largest number of new cases occurring in 2008, and over 350 per population of 100,000 reported in sub-Saharan Africa.

On World Tuberculosis Day marked on March 24, WHO appealed to all people across the globe to join in the fight to declare the world free of the disease. This means zero deaths from TB, faster treatment, quick, affordable testing and an effective vaccine.

The first case of MDR TB in Kenya was detected at KNH in 2007. The government then introduced the free treatment programme in 2008.

A TB specialist at KNH Eunice Wahome, said the hospital, which is also treating MDR TB patients from other East African countries, mainly from Uganda, has received 70 cases so far.

“About five per cent of the patients we receive contract it through other patients.”

In Kenya, KNH, Moi Referral Hospital in Eldoret in the Rift Valley, Port Reitz on the coast and Homa Bay Hospital in Nyanza are the only hospitals offering free treatment.

Tanzania started diagnosing and treating the disease last year while Uganda does not offer MDR TB treatment.

“Poor treatment, misdiagnosis and the use of counterfeit drugs are common triggers of MDR TB,” said Dr Wahome.

She said once a patient is diagnosed, it is important that they are isolated.

“For example, in a home setting, they should be given a separate room that is well ventilated,” said Dr Wahome. “In the case of a new mother, it is advisable they stop breastfeeding and leave the child in the care of someone else until they complete treatment.”

The WHO advocates for directly observed therapy (DOTS) under the supervision of health care workers to reduce the emergence of drug resistance.

“Every TB patient is supposed to be supervised when taking medication in order to increase adherence and decrease emergence of drug resistance,” Dr Wahome said.

The MDR TB treatment takes a minimum of 20 and a maximum 30 months depending on the stage and extend of infection.

The drugs administered include an injection and five types of tablets to be taken daily.

The entire treatment regimen costs between Ksh1.5 million ($18,000) and Ksh3 million ($36,000).

But now, KNH is grappling with a fresh challenge — a new strain of TB called XDR TB (extensive drug-resistant tuberculosis), which is resistant to first and second-line drugs.

“The XDR TB patients are said to be resistant to two more MDR TB drugs a kanamycin injection and a quinon drug,” said Dr Wahome.

KNH received the first case in 2010 and so far, three patients have been diagnosed. Two died and the remaining patient has been quarantined.

“Little is known about the cause of XDR TB and no standard treatment regimen is available” said Dr Wahome.