KENYA: XDR-TB case raises questions
TB screening needs to be improved
NAIROBI, 28 February 2012 (IRIN) - The Kenyan government's recent failure to adequately treat a patient with extensively drug-resistant tuberculosis (XDR-TB) has some civil society organizations questioning whether the country's TB programme is equipped to diagnose and treat such patients.
In October 2011, an HIV-positive Nairobi woman was diagnosed with XDR-TB while receiving her treatment at the Kenyatta National Hospital for multi-drug resistant TB (MDR-TB). Treatment was provided by the hospital; however, she was prescribed three additional medicines that she had to buy herself, to supplement the regimen.
According to Allan Maleche, coordinator of the Kenya Legal and Ethical Issues Network on HIV and AIDS, KELIN, following a public outcry over the handling of the patient's case, the government has stepped in to pay for all her medication. But Maleche warned that more still had to be done.
“The government needs to have a policy that outlines clearly how it will deal with cases of XDR-TB because at the moment that is missing. The government must also invest in the treatment and care of XDR-TB patients in Kenya," he told IRIN/PlusNews.
MDR-TB is resistant to the two most powerful anti-TB drugs, while XDR-TB is resistant to these and at least two others. XDR-TB patients, who pose the greatest public health risk, are also the most difficult to treat. It costs about US$35,700 to treat a single case of XDR-TB per year and the treatment normally runs between 24 and 36 months.
“We have so far received only three cases of XDR-TB. Two have since died and one is on treatment. But it is difficult to say the exact number of such cases out there because no study has been done to ascertain this," said Joseph Sitienei, director of the National Leprosy and TB Control Programme.
There more than 500 known cases of MDR-TB in Kenya, and only 230 of these are on treatment, but activists warn that more cases could be going undetected.
|The resources that are available ... cannot cope with the burden of the disease as it is today. It is important to remember there are other health concerns competing for the little resources available
The government admits the TB programme in Kenya has not been adequately funded despite the country’s big TB burden. Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.
"The resources that are available... cannot cope with the burden of the disease as it is today. It is important to remember there are other health concerns competing for the little resources available," Sitienei told IRIN/PlusNews.
“We are looking for resources to enhance our capacity to deal with cases of both MDR-TB and XDR-TB in order to buy medicines and we are currently in the process of setting up a state of the art isolation ward at Kenyatta National Hospital. But as of today, individual health facilities have some sort of isolation wards that can be used from time to time," he added.
Another major challenge is that TB patients either report late to health facilities for diagnosis or default on their treatment, increasing their chances of developing drug-resistant TB.
Sitenei admitted that TB surveillance had to be improved, as the screening of MDR-TB patients for XDR-TB is "lacking".
“The government will also be training health personnel to be able to adequately do the screening... at the moment, we don’t have the capacity to adequately do the screening."
TB is the biggest killer of people living with HIV. The Kenya National AIDS Strategic Plan 2009-2013 notes that despite the fact that 80 percent of TB facilities provide HIV testing, just about 27 percent of HIV-positive TB patients receive antiretroviral treatment.
“The government has a policy to integrate TB and HIV programmes, but a lot still needs to be done to realize success. Health workers must be continuously sensitized on the need for the integration of care and treatment of the two diseases,” said Nelson Otuoma, coordinator of a local lobby group, Network of People living with HIV/AIDS in Kenya.