Maureen (not real name), an HIV+ mother of two, is a Multi-Drug Resistant Tuberculosis (MDR-TB) survivor. Her story is similar to many other TB patients who have contracted TB unknowingly. Maureen contracted Tuberculosis (TB) in 2013 while on a bus from Arua to Kampala. “A man seated behind me, in the bus coughed so hard, and the smell of his breath was so bad,” she narrates. Maureen adds that she started coughing the next day and the cough stayed for a while, “I coughed for about two weeks, and it was so painful on my right side, that is when my aunt advised me to visit the hospital after all the medication we tried, had failed.”
When Maureen visited Arua Regional Referral Hospital, she tested positive for TB. She was immediately put on Directly Observed Treatment (or DOTs) regimen, the standard treatment for TB that lasts for six months. The treatment entails swallowing tablets taken at the same time of day for six months under the supervision of a trained health worker. If taken diligently as specified in the guidelines, the chances of curing of TB are as high as 95%.
However, a month after starting the treatment, Maureen stopped taking the drugs. “I reached out to my pastor and my peers who prayed for and counselled me and I believed I would be okay without the rigorous medication. Besides, I had started feeling better,” she says.
Treatment of TB requires dedication from the patient to swallow drugs until the doctor advises the patient to stop. Ceasing treatment without a doctor’s advice or not taking it as prescribed can lead to resistance to the available medications by the TB causing bacteria. This makes the disease more difficult and expensive to treat.
The WHO Global Tuberculosis Report 2017, shows that an estimated 4.1% of TB cases are now reported to be resistant to standard first-line medicines, of which an estimated 6.2% are extensively drug-resistant, or MDR-TB. This means that the bacteria are resistant to at least two groups of second-line drugs, injectables and fluoroquinolone, in addition to first-line medicines.
Maureen developed a persistent painful cough after ceasing treatment. She again visited the hospital and was put on the standard first-line treatment but her symptoms worsened with time. “They took me to radiology and took sputum tests. At first, the results showed that I had TB, but three days later the doctor called me and told me I tested positive for MDR-TB.”
“I cried a lot because I have a lot of responsibilities on me. I am the breadwinner for my kids, my siblings and their kids,” she adds.
At this stage, she was referred to the MDR clinic and was put on medication, “it was hectic because I had to swallow about seventeen (17) tablets and injections every day, for nine months. I am grateful for the support I received from my family and the health workers at Arua Hospital MDR clinic,” she says.
Maureen is now among the counsellors at the MDR clinic, where she shares her story with the newly admitted patients with particular emphasis for them to adhere to treatment. “I now advise the patients to take their medication seriously and not to give up because, here I am, a living testimony that MDR-TB is curable. I have also talked to different families not to stigmatize their members in case any of them contracts the disease because their support is also important,” she adds.
To mark the World TB day 2018, national commemorative activities were held in Arua district where, the Minister of State for Health, Hon Sarah Opendi called on the public to seek TB services. “TB diagnosis is free, TB treatment is free and the drugs are available at no cost,” she said. She further called on all leaders, to create awareness and advocacy on TB to reduce the prevalence of the disease.
The Regional Director for the World Health Organization Regional Office in Africa (WHO-AFRO), Dr Matshidiso Moeti also reiterated the Minister’s statement. In remarks read on her behalf by Dr Kaggwa Muggaga, the TB Focal person at the WHO Uganda Country Office, Dr Moeti said that “leaders have the tremendous influence to build strong partnerships and commitment to ending the TB epidemic at every level. I, therefore, call on governments, parliamentarians and policy-makers to drive ambitious plans that will accelerate TB control at national level.”
Dr Moeti implored health workers, non-governmental organizations and technicians to maximize the use of proven methods to diagnose and successfully treat all types of TB, and for researchers to do the scientific studies needed to inform policies to help improve and monitor TB services.
Together with the Global Fund and the United States Agency for International Development, NGOs and community partners, WHO is supporting the Government of Uganda to improve diagnosis, surveillance and treatment of TB all over the country. A lot of advocacy work has also been towards tackling stigma and raising awareness on available services. WHO has supported extensive training of health ministry staff in DR-TB diagnostics using GeneXpert technology, clinical case management and development of DR-TB specific guidelines.