Mantoe Phakathi

MBABANE, Apr 6 2011 (IPS) – The fight against tuberculosis in Swaziland will be reinforced on two fronts this month. A new tool for the quick and accurate diagnosis of TB will begin its roll out and a monthly stipend for treatment supporters will help ensure patients get through the lengthy and unpleasant course of TB drugs.

Treatment supporter Zodwa Mhlabane talks to a patient. Credit: Mantoe Phakathi/IPS

Swaziland declared TB a national emergency on Mar. 24, World Tuberculosis Day. Swaziland has an estimated 11,000 TB patients, including 400 who have drug resistant strains of the disease.

TB is the leading cause of mortality in the country. It is also one of the primary opportunistic diseases that aggravates the AIDS pandemic.

Government has received a 40 million dollar grant from the Global Fund to help intensify the response against TB now that the disease is declared a national emergency, said National TB Programme manager Themba Dlamini.

The financial support from the Global Fund against AIDS, TB and Malaria will be used to implement a newly-developed multi-drug resistant-TB test which returns a result within two hours.

Better testing
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One of the factors that drives the spread of TB is the many undiagnosed cases. A TB test result can be returned in a day, but it presently takes up to two months to get results for drug-resistant TB.

People are at their most infectious while they are not on a course of treatment; the long delay between a TB test and a result often results in poor follow-up with patients to begin anti-TB drugs, leaving them to pass on the disease which is readily transmitted when an infected person coughs, sneezes, talks or spits.   The new test, which the World Health Organisation announced in March, will not only assist with swift detection, it will help the Swazi government in its effort to decentralise TB services throughout the country.

The new MDR-TB test called Gene Xpert test will also be used at clinics because it doesn t have a lot of bio safety requirements, he said. It is also very reliable when used correctly.

Currently, the TB case detection rate in the country is 88 percent while WHO sets a target of 100 percent. The TB treatment success rate at the moment stands at 68 percent against the 85 percent requirement by the world health body.

Presently, only 32 out of the country s 182 health facilities 17 hospitals and health centres and 162 clinics have the capacity to diagnose and initiate TB treatment.

Before the end of the year, government will have accredited 31 more clinics to diagnose and initiate TB treatment, said Dlamini.

The new test is also cheaper than the current test: it will cost 16 dollars per patient versus 58 dollars for the present laboratory test.

It is hoped that Gene Xpert test and other technological developments that are in the pipeline offer a renewed hope for transforming the fight against TB from control towards elimination, said WHO country representative Dr Owen Kaluwa.

Better treatment

The Global Fund money will also be used to support community counsellors like Albertina Nyatsi.

Nyatsi, along with about 40 other community health motivators WHO volunteer to support and monitor TB patients taking medication, faces a challenging task.

People dislike taking the medication because of the side effects including nausea, fatigue, swollen feet, blindness and some patienst suffer mental problems. Health motivators have to visit drug-resistant TB patients twice a day to observe them taking their medicine. She often has to travel long distances at her own cost to visit patients.

Most patients take their medication in the evening and it s dangerous for us to walk back home, said Nyatsi. I need money for transport.

Treatment supporters are often as poor as the people they serve, and Nyatsi confides that with no income every month, she cannot even afford an umbrella to protect herself when she must make her rounds in the rain.

But if she misses her appointments, it can be serious, she says. It s very critical that a treatment supporter observes the patient while they take drugs daily because the medication is very irritating and sick people often stop taking it if there is no one to encourage them.

While the National TB Programme assigns family members to support their relatives suffering from TB, dedicated people are needed when it comes to drug resistant TB which has become a serious concern in the country.

We have to control the spread of MDR-TB by all means because this is a very complicated TB strain which is very difficult and expensive to diagnose and treat, said Dlamini.

While it takes six months to treat normal TB, MDR-TB can only be successfully be cured after a period of 24 months.

The government will now have the resources to ensure that treatment supporters receive a stipend of 60 dollars each month. Dlamini said government wants to ensure that every MDR-TB patient has a trained community health motivator to see them through.

We re going to start with MDR patients because supporting them tends to be labour intensive given that they take medication twice a day, said Dlamini.