Mantoe Phakathi interviews THEMBA DLAMINI, Swaziland National TB programme manager
MBABANE, May 16 2009 (IPS) – Swaziland saw a 5.6 percent increase in tuberculosis cases between 2008 and 2007. Out of a population of one million, 10,000 are infected with TB, one of the highest rates of TB infection in the world.
Themba Dlamini: hopes new monitoring programme will improve adherence to TB treatment. Credit: Mantoe Phakathi/IPS
Swaziland also has the highest HIV prevalence in the world, with 26 percent of the economically vital age group between 15 and 49 infected.
National Tuberculosis Programme manager Themba Dlamini told IPS reporter Mantoe Phakathi that the two epidemics are closely related, with HIV lowering resistance to TB infection.
But TB is a completely treatable and curable disease: why are cases in Swaziland continuing to rise? Dlamini explains that many patients are failing to take the drugs they are provided properly.
IPS: Why are so many people failing to adhere to treatment? Themba Dlamini: There are a number of reasons why many patients fail to adhere to prescription. One of these is that most of our patients cannot afford transport to clinics and hospitals where they collect their TB drugs and also get examined to monitor their progress.
Some of them also do not have food, yet it s not advisable to take drugs on an empty stomach.
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And of course taking drugs for a long time is not an easy task which is why some patients end up giving up.
IPS: Why is the default rate so high among TB patients compared to anti-retroviral therapy (ART) patients? TD: People on ART receive more counseling compared to TB patients. Once you re diagnosed with TB you undergo treatment immediately yet with ART the process is gradual because if your CD-4 count is high you delay taking drugs.
Therefore, TB patients find themselves under a lot of pressure because they are not prepared for the treatment.
IPS: What are the dangers of TB patients defaulting on their treatment? TD: The problem is that once patients fail to drink the right combination of tablets at the time stipulated by the doctor every day, they develop MDR (multi-drug resistant) TB which is a TB strain that cannot be treated with the first-line drugs.
MDR-TB is treated with second-line drugs which are very expensive. While it takes six to nine months to treat normal TB, it takes between 24 to 36 months to treat MDR-TB patients.
With XDR (extremely drug resistant) TB it is even worse because there are no drugs to treat this TB strain. We have 104 MDR and three XDR patients all who are admitted at the TB hospital in Manzini.
IPS: How is government to ensure that all patients adhere to treatment to try and bring the impact of the disease under control? TD: We will introduce a Patient Support Programme in the next few months which is part of the Directly Observed Treatment Short-course (DOTS) strategy.
DOTS entails that somebody must monitor TB patients as they swallow their tablets on a daily basis. We don t give TB patients drugs unless they come with someone who will promise that they would observe the patient each time they swallow their medication.
However, that has not yielded the desired results because some relatives and family members fail to keep their promises.
IPS: So how is the patient support programme going to work? TD: Under this programme, patients who are on treatment will be given money to travel to health centres so they can collect their drugs and get medical examination. Patients will get $20 for transport every two months [the interval at which they are expected to refill their prescriptions].
On top of that, government will make sure that TB patients also receive food parcels. We are going to solicit assistance from the World Food Programme in this regard because we don t have the capacity to distribute food rations.
IPS: How do you hope to ensure that the patients do not misuse the money meant for their transport to health centres? TD: We are still going to work around that. There are a number of options one of them is that the money should be kept at the clinics and taken to the patients when they are due for their appointment. But definitely we wont give patients the money before they are due because it can be misused.
IPS: So you assume that if you give the patients money for transport and food they will adhere to treatment? TD: Government will also get volunteers who will work as treatment supporters in all the 120 clinics in the country. Each clinic will be allocated two treatment supporters, while clinics in bigger areas will get four.
The treatment supporters will follow up on TB cases at community and family levels. We want them to ensure that those relatives who promised that they would ensure that patients adhere to treatment keep their promises.
The treatment supporters will earn $75 a month.
IPS: How will these treatment supporters go about their duties, especially where family and community members are still expected to support TB patients take their medication? TD: Treatment supporters will be making daily or weekly home visits to patients to ensure that they adhere to treatment. They will be reporting to the nurses at the clinics on the progress of the different TB patients in their areas.
IPS: Are these TB treatment supporters also going to double as ART treatment supporters? TD: Not necessarily but they assist patients who are on both TB treatment and ART.
IPS: What about those patients who are too weak to travel in public transport? TD: We have an ambulance that goes out to the communities to pick up such patients and bring them to the health centres.
However, this system is still weak because there are too many patients. We ll buy another ambulance under the Patient Support Programme to ensure that all patients who cannot use public transport are also assisted.
IPS: Where will the money for this programme come from? TD: We have received $250,000 from the Global Fund per year for the next five years to fund this programme. Although there is the question of what will happen after fives years, we say we have to save lives now while we think of other options.
After the five years government might even consider taking over this programme or we would have secured another funding from other donors by that time. For now let s make do with what we have and save lives.