Kenya: HIV/TB co-infection and challenges
by HDN Key Correspondent Team
In the past decade, there have been increasing campaigns geared towards TB treatment and many Kenyans have been treated under the free medical scheme (for TB patients). But the rise in number of TB patients has also coincided with the rise in HIV infection rates.
This has stretched the Ministry of Health’s ability to cope with the twin epidemics and at the same time resulted in many deaths. Stigma has also been extended to TB patients and in some areas TB is equated with HIV infection. This means that some people do not seek medical attention for fear of knowing their HIV status and others prefer TB treatment and do not test for HIV.
Dr. Chakaya Muhwa, Kenya’s head of National Leprosy and TB Control Programme (NLTP) confirms that the increase in TB cases has coincided with emergence of HIV/AIDS. “In 2003 there were over 96,000 cases of TB and 80% were successfully treated. Five per cent died while receiving treatment while 15 per cent were not followed up or were transferred from their treatment centres,” Dr Chakaya says.
Co-infection still a challenge
Whilst co-infection remains a major challenge, the government and other independent medical agencies have embarked on HIV/AIDS education campaign and a TB treatment campaign as two separate exercises, according to Dr Ernest Nyamato.
Dr Nyamato, who works in Nairobi’s Mathare slums, says that TB affects many people living with HIV and it is likely that 50 per cent of HIV patients will get TB at some point in their lives.
In this respect, Nyamato says there is dire need to address the two epidemics together as they are affecting the society in large numbers. The Kenyan government’s official policy is Directly-Observed Therapy, short course (or DOTS) but, according to Dr Nyamato, superior regimens are available, especially for HIV patients, that can guard against re-infection with TB. In his opinion, the insistence on DOTS is based on funding dictates. He argues that “many donors to the health ministry insist on DOTS even though the ministry has its misgivings”.
“It is possible to limit re-infection through the use of superior treatment regimes that are only available in private hospitals and at a higher cost,” Nyamato says. Asked about his misgivings about DOTS, Dr Nyamato says DOTS can limit access; it may overload the TB network if treatment is spread countrywide. This will happen especially if the TB clinics and other facilities such as modern laboratories are not put in place to ensure that people are well attended to.
“There is scarcity of facilities to test TB that may result from [HIV] co-infection such as TB of the intestines, bones, and liver. Right now, under the DOTS programme testing is limited to sputum,” Dr Nyamato adds.Dr Nyamato says some hospitals in Kenya, which are reeling from the ever-increasing brain drain from the country, may not have enough personnel to supervise patients taking drugs since these hospitals insist on personal observation. Moreover, some of the hospital laboratories are in a dilapidated state, often with obsolete equipment, and need state-of-the-art laboratories to guarantee proper testing.
In his experience, there has been inadequate screening of patients to differentiate between TB and other ailments such as bronchitis. This, the doctor maintains, will not only need modern laboratories but also well trained/retrained medical personnel. Given that DOTS is labour intensive, strict DOTS implementation will overstretch resources. In this respect, Dr Nyamato says concerted budgeting efforts will be needed from the government to ensure it can reach all those who need treatment.
“The government has to decentralize to the village level. Right now, administration of TB drugs is centralized so you can only access in hospitals like Kenyatta National Hospital or Mbagathi Hospital. If you are lucky, you can get treatment from international agencies like Medicines sans Frontieres (MSF),” Dr Nyamato argues.
On administration of drugs, Dr Nyamato recognizes the need for harmony. He wonders why TB patients have to be supervised while taking drugs while we trust HIV patients to go home with a month’s dosage. “ARVs do not need to be administered in DOTS. Right now, 90% of our HIV patients take their ARVs so we can trust they will take their TB medication. It is a double standard to tell the patients to go home with ARVs then come to hospital every day for TB tablets” he adds.
Pursuant to this line of thought, Dr Nyamato is engaged in a pilot study on modifying DOTS at the Mathare slums. The project will also explore change of regimen to give rifampicin for the entire eight-month period to establish how it can assist the patients.Mathare is also engaged in a project testing how the sputum can be tested better to give more accurate results. Under this pilot project, patients will also be educated on how to take charge of their lives and their medication.
The project will start by administering weekly dosages then move to monthly dosages. This will help to establish the rate of compliance.
HDN Key Correspondent TeamEmail: correspondents@hdnet.org
In the past decade, there have been increasing campaigns geared towards TB treatment and many Kenyans have been treated under the free medical scheme (for TB patients). But the rise in number of TB patients has also coincided with the rise in HIV infection rates.
This has stretched the Ministry of Health’s ability to cope with the twin epidemics and at the same time resulted in many deaths. Stigma has also been extended to TB patients and in some areas TB is equated with HIV infection. This means that some people do not seek medical attention for fear of knowing their HIV status and others prefer TB treatment and do not test for HIV.
Dr. Chakaya Muhwa, Kenya’s head of National Leprosy and TB Control Programme (NLTP) confirms that the increase in TB cases has coincided with emergence of HIV/AIDS. “In 2003 there were over 96,000 cases of TB and 80% were successfully treated. Five per cent died while receiving treatment while 15 per cent were not followed up or were transferred from their treatment centres,” Dr Chakaya says.
Co-infection still a challenge
Whilst co-infection remains a major challenge, the government and other independent medical agencies have embarked on HIV/AIDS education campaign and a TB treatment campaign as two separate exercises, according to Dr Ernest Nyamato.
Dr Nyamato, who works in Nairobi’s Mathare slums, says that TB affects many people living with HIV and it is likely that 50 per cent of HIV patients will get TB at some point in their lives.
In this respect, Nyamato says there is dire need to address the two epidemics together as they are affecting the society in large numbers. The Kenyan government’s official policy is Directly-Observed Therapy, short course (or DOTS) but, according to Dr Nyamato, superior regimens are available, especially for HIV patients, that can guard against re-infection with TB. In his opinion, the insistence on DOTS is based on funding dictates. He argues that “many donors to the health ministry insist on DOTS even though the ministry has its misgivings”.
“It is possible to limit re-infection through the use of superior treatment regimes that are only available in private hospitals and at a higher cost,” Nyamato says. Asked about his misgivings about DOTS, Dr Nyamato says DOTS can limit access; it may overload the TB network if treatment is spread countrywide. This will happen especially if the TB clinics and other facilities such as modern laboratories are not put in place to ensure that people are well attended to.
“There is scarcity of facilities to test TB that may result from [HIV] co-infection such as TB of the intestines, bones, and liver. Right now, under the DOTS programme testing is limited to sputum,” Dr Nyamato adds.Dr Nyamato says some hospitals in Kenya, which are reeling from the ever-increasing brain drain from the country, may not have enough personnel to supervise patients taking drugs since these hospitals insist on personal observation. Moreover, some of the hospital laboratories are in a dilapidated state, often with obsolete equipment, and need state-of-the-art laboratories to guarantee proper testing.
In his experience, there has been inadequate screening of patients to differentiate between TB and other ailments such as bronchitis. This, the doctor maintains, will not only need modern laboratories but also well trained/retrained medical personnel. Given that DOTS is labour intensive, strict DOTS implementation will overstretch resources. In this respect, Dr Nyamato says concerted budgeting efforts will be needed from the government to ensure it can reach all those who need treatment.
“The government has to decentralize to the village level. Right now, administration of TB drugs is centralized so you can only access in hospitals like Kenyatta National Hospital or Mbagathi Hospital. If you are lucky, you can get treatment from international agencies like Medicines sans Frontieres (MSF),” Dr Nyamato argues.
On administration of drugs, Dr Nyamato recognizes the need for harmony. He wonders why TB patients have to be supervised while taking drugs while we trust HIV patients to go home with a month’s dosage. “ARVs do not need to be administered in DOTS. Right now, 90% of our HIV patients take their ARVs so we can trust they will take their TB medication. It is a double standard to tell the patients to go home with ARVs then come to hospital every day for TB tablets” he adds.
Pursuant to this line of thought, Dr Nyamato is engaged in a pilot study on modifying DOTS at the Mathare slums. The project will also explore change of regimen to give rifampicin for the entire eight-month period to establish how it can assist the patients.Mathare is also engaged in a project testing how the sputum can be tested better to give more accurate results. Under this pilot project, patients will also be educated on how to take charge of their lives and their medication.
The project will start by administering weekly dosages then move to monthly dosages. This will help to establish the rate of compliance.
HDN Key Correspondent TeamEmail: correspondents@hdnet.org
posted by AIDS-Care-Watch at 7:35 am
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