09 Jul 2008 | Interview

Dr Aoua Hima Oumarou, a tuberculosis consultant working in Nhlangano, explains the reasons behind the TB epidemics and the high number of resistant TB cases and the way MSF and the National TB program intend to fight against it.

Swaziland meets a number of conditions explaining this incidence of tuberculosis and, worse still, the large number of drug-resistant cases. This is a very contagious infection. According to the WHO, a contaminated patient, if untreated, can infect up to 20 persons every year. Furthermore, the HIV/AIDS virus favours the spread of tuberculosis. Therefore in this HIV/AIDS pandemic situation, the number of TB cases can only increase. Additionally, with more than 5% of patients abandoning their treatment and with more than 8% resuming it, resistance to drugs is getting worse. This means that drugs are getting less and less effective against an illness that adapts, evolves and resists to drugs.

 

In Shiselweni region, 15.6 per cent of patients abandon their treatment in mid-course. Thirty-nine patients suffering from a drug-resistant form of TB were treated between the beginning of 2006 and April 2008, 21 of them following MSF’s arrival in November 2007. This variety of multidrug-resistant TB, also known as “MDR”, has been diagnosed in 26 patients, with one case of extensively drug-resistant tuberculosis or “XDR TB”. The patient suffering from this XDR TB was a cleaner working in the Hlatikulu wards. She was probably infected in the wards. Before MSF’s arrival in the region, the absence of precautionary measures for staff and patients alike helped spread TB infection within the very health care structure.

 

Before MSF’s arrival the decision to begin an antituberculosis treatment, when the presence of the BK bacillus could not be confirmed, rested with a single doctor or a number of nurses for the whole of the country. Likewise, this team alone could decide to halt the treatment for patients across the kingdom. Therefore, it was difficult to care for patients in a timely manner.

 

Drug supply to ensure patients’ treatment is also of great concern. Instances of untimely stock shortages are frequent and the quality and origin of drugs remain undefined. Therefore, MSF has temporarily replaced Swaziland’s health care authorities to ensure a clinical examination of patients at a regional level, improve the quality of lab diagnosis and to ensure treatment when required. MSF is also doing its best to improve the quality and supply of drugs needed to treat tuberculosis.

With a TB and HIV/AIDS coinfection rate of nearly 80 per cent in Swaziland, what are the steps taken to meet the needs of patients?

Our approach has been to say: “one patient, two infections, one carer”. MSF staff is trained to be multi-skilled. Each TB-infected patient is systematically screened for HIV/AIDS infection. Likewise, Each HIV/AIDS-infected patient is systematically screened for TB infection. The aim is to see all medical or paramedical staff have this reflex when a patient turns up at a care centre or treatment ward in a large centre or a smaller clinic. The treatment of patients coinfected with HIV/AIDS and TB is concurrent and is intervening at all levels of care.

 

In the coming months, MSF will concentrate its action on the screening for drug-resistant tuberculosis in communities. MSF will also try to increase the transfer of sputum samples collected in rural community clinics to care centres and hospitals equipped with labs. This should speed up the care of patients who live far from the main care centres but need treatment.