MDR-TB: The battle is on

Sweating profusely had become the order of day for 32-year-old Ms Grace Barangire of Shamva. Struggling to breathe, Ms Barangire sounded like she was whispering when she spoke.

Needless to say, the stigma weighed heavily.

Confused by her weight loss, Ms Barangire finally decided to visit Karoi District Hospital. There she was told she had multi-drug resistant tuberculosis (MDR-TB).

Puzzled by how she could have contracted MDR-TB when she had never been treated for TB or remember being in contact with anyone with the disease, Ms Barangire found it difficult to accept the diagnosis.

“After having suffering from a number of symptoms I then decided to visit Mwami Clinic where the nurse took my sputum and a few hours later I was told that I am suffering from MDR-TB,” she explained, almost in tears.

“I couldn’t believe it and still can’t, even though I started the treatment for MDR-TB a month.

“I asked myself what is it about me that I suffer from MDR-TB when I never had TB before?”

MDR-TB is a type of tuberculosis caused by a bacterium, mycobacterium tuberculosis, that has developed a genetic mutation such that a particular drug or drugs is no longer effective against the bacteria.

Health experts concluded that MDR-TB is resistant to at least isoniazid and rifampicin, the two most potent anti-TB drugs.

While DR-TB is usually blamed on patients who do not adhere to TB treatment and, therefore, develop resistance, Ms Mugova has a unique case.

Karoi district TB focal nurse Mr Stephen Makwengwe said there were two main forces driving the DR-TB outbreak.

“The first is generation of DR-TB through mismanagement of patients being treated for pan-susceptible disease and the second is ongoing transmission of drug-resistant TB in the community,” he said.

“What could have happened to Ms Barangire could have been an unfortunate case of her getting into contact with the resistant bacteria coughed up by someone infected with it, a factor that explains the surge of the disease in the country.”

After seeing nurses wearing face masks treating her at her isolated make-shift ward, people around are now afraid of Ms Barangire.

While stigma is one of her worries, Ms Barangire’s greatest worry is nutrition since the medication requires she eats well.

“With the tablets and injections that I’m taking they require that I constantly eat nutritious food for them to work well and not give me pain but the problem is I don’t go to work,” she said.

“And my condition doesn’t allow me to socialise, I’m expected to be in isolation till my sputum tests negative again.

“And so getting nutritious food is a struggle for me.

“I’m trying my best to protect my family and other people from contamination hence I have decided to stay in hospital till I test negative.”

Although the Global Fund has a monthly allowance for DR-TB patients to supplement their diets, affected people feel the amount is insufficient.

“Even though it’s a noble initiative, I still feel that US$25 being donated to MDR-TB patients is too little considering our dietary requirements,” said Ms Barangire.

Health experts say poor nutritional status is common with people with active TB. The disease may lead to underweight and micro-nutrient defiencies by increasing energy requirements, poor metabolism and loss of appetite.

MDR-TB is the greatest health threat that the country is facing, worsened by poor nutrition, housing and living conditions.

Ms Barangire is expected to be in isolation during the intensive care or at least in a well-ventilated house.

Mr Makwengwe, the nurse managing Ms Barangire, said he is afraid of being infected too but there was nothing he could do as this was part of his job.

“Anyone who is contact with a MDR-TB patient with a positive sputum is at risk of contracting the disease, hence you see me wearing a mask when I administer treatment to them,” he explained.

Ms Barangire’s life reflects that of over 800 DR-TB patients on treatment across the country.

Karoi district medical officer, Dr Annamore Mutisi, said they have 13 DR-TB patients on treatment in the district.

Dr Mutisi said lack of isolation space for the patients is a challenge as it is key that they are kept in isolation to avoid spreading the disease.

“If we could have them hospitalised during the first six months or at least until there is negative sputum conversion, this would help us manage and keep them in treatment,” she said.

“The introduction of GeneXpert machines in hospitals has helped increase detection hence we now have more patients on treatment.

“This district, because of a high presence of mining activities, was first prioritised to have a GeneXpert machine and it has really helped.”

According to health experts, DR-TB is an all-consuming two-year long process which is too expensive to treat than the drug susceptible TB and GeneXpert machines are used to easily spot it.

DR-TB is 80 times more expensive type, treated using first-line therapy drugs at US$31 for the whole course per patient compared to more than US$2 500 for the resistant type.

So while Government and its partners look for possible best ways of DR-TB management, Ms Barangire will continue take her possible two-year treatment.

Zimbabwe’s MDR-TB burden is unknown.

However, World Health Organisation estimated that the country had 820 MDR cases among all TB cases in 2014 basing on the 1994 survey which revealed that 1,9 percent of new TB cases and 8,3 percent of previously treated cases were MDR.

According to the 2014 Global Tuberculosis Report, the estimated incidence of MDR-TB is 480 000 worldwide.

WHO in 2015 availed guidelines for a shorter and cheaper treatment regimen as well as a rapid diagnostic test for MDR-TB aimed at improving treatment and speed up detection.

At a cost pegged at less than US$1 000 per patient, the new treatment regimen can now be completed between nine and 12 months.

Health and Child Care ministry’s director for Aids and TB Unit, Dr Owen Mugurungi, said this is a critical step forward in tackling the MDR-TB public health crisis.

“The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients/

“They can now benefit from a test that quickly identifies eligibility for the shorter regimen and then complete treatment in half the time, at nearly half the cost,” he said.

“We will look at the new guidelines and try to adopt them but it won’t be a quick transition from the current existing regimens we have. The only challenge is we buy medicines in advance and even if we adopt the new guidelines today, we still have to exhaust what we have in stock.”

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