Greater Coordination Needed To Tackle TB In Zambia

It is Friday morning and Ngandu* is supposed to take his tuberculosis (TB) medication.

He lives in Kanakantapa, a farming area east of Lusaka. He realizes that he does not have enough medication to last over the weekend and his treatment review is on Monday.

Ngandu rushes to the roadside to find transport to the nearest health centre, the Chelston Clinic. But when he arrives at noon, the centre's TB staff have already knocked off work for the day.

He pleads with the pharmacist for enough medication to last until Monday but she refuses, saying she is unable to store or dispense TB medicine.

Ngandu is forced to go home empty-handed and is certain to miss some of the doses he needs as the TB corner of the centre is only open from 8am to 1pm from Monday to Friday. This scenario is all too common.

What will happen to Ngandu? He is more likely to become resistant to his medication as a result of the interruption to his treatment. Situations like Ngandu's are one of the causes of multi-drug resistant TB (MDR TB).

Other factors contributing to the rates of MDR TB include the consumption of alcohol among recovering patients. As many nurses and TB support staff in Zambia are not trained counsellors, some patients are not adequately prepared when they start taking their medication.

Myths, such as the one claiming that a positive TB result is also a positive HIV result, cause some people with TB to shun treatment completely because they are afraid of the stigma associated with either disease.

The Zambian government should be concerned about the outbreak of extensively drug-resistant TB (XDR TB) in South Africa as high numbers of border traders cross between the two countries regularly. The medication needed to treat MDR TB alone is expensive with treatment taking up to two years.

Even the tests for this strain of TB are extremely expensive and Zambia still does not have the necessary laboratory equipment to carry out drug sensitivity tests to monitor patients ' responses to treatment.

Most health centres rely on sputum tests to diagnose TB as many do not have X-ray machines. Those that do have working X-ray equipment, charge between US$2.50 and $3.50, prices that are unaffordable to many people.

Some people reject TB treatment because of the lengthy recovery time and prefer traditional remedies, which have no proven clinical benefit. The prospect of standing in a long queue to receive their results is another factor discouraging people who fear stigmatisation from attending health clinics.

There is little privacy at TB clinics, which are often located in the corner of a health centre. The contact between high numbers of patients and clinic staff increases the risk of TB transmission and some patients attribute long queues to a lack of equipment and human resources.

Many of Zambia's TB patients do not have adequate diets, leaving them more susceptible to the disease. This needs to be addressed urgently. The World Food Programme should look into providing food supplements to TB patients, since the disease is treatable only with the right diet and medication.

No one seems to know if the government has any policies protecting people living with TB and HIV and it is unclear to what extent the declarations that Zambia has signed are being implemented. Few health workers, counsellors or people living with TB or HIV have seen statements such as the Abuja Declarations of 2000 and 2006 and many have not heard of the World Health Organization 's interim policy on TB/HIV collaborative activities.

The directly observed treatment-short course (DOTS) programme has worked very well but there needs to be more collaboration between TB and HIV treatment programmes and, like antiretroviral (ARV) clinics, TB centres need to be open from 8am to 5pm.

TB health staff are paid full salaries but in some cases only work until lunchtime, which is unfair to people who live in remote areas and have to travel long distances to access treatment. People living with TB or HIV should be represented in country coordinating mechanisms (CCM) and the National AIDS Council (NAC) so that their needs are addressed and information on policy reaches patients and health-care staff.

In other African countries, the diagnostics, counselling and testing (DCT) model has proved more successful than voluntary counselling and testing (VCT). In Zambia, people who test positive for TB are referred for VCT but there is no system in place that ensures that this occurs. If DCT is implemented, patients will be encouraged to make informed decisions about HIV testing.

Zambia 's TB patients are not receiving adequate counselling and do not have the information they need to encourage them to be tested for HIV.

Greater collaboration should be encouraged between the TB and HIV treatment programmes, as this will reduce not only costs but also the transport burden on patients. Access to diagnostics, treatment and counselling will be easier for patients if TB and HIV programmes are more closely coordinated.

* Ngandu is a fictional name.

by: Michael Mwiinga Gwaba (Zambia)
(Michael Mwiinga Gwaba is a Key Correspondent to Health & Development Networks (HDN). Website: www.TheCorrespondent.org, email: info@thecorrespondent.org)

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