In-depth: TB and HIV: Deadly allies

ZIMBABWE: Health crisis whacks TB efforts

Photo: Gary Hampton/World Lung Foundation
Many TB patients depend on state hospitals for treatment
Harare, 24 March 2009 (PlusNews) - By the time Tichaona Paraziva, 49, tested HIV positive at the end of 2006 he was already in need of antiretroviral (ARV) treatment, but there was a waiting list for the free government programme and on a teacher's salary he could not afford to buy medicines in the private sector.

He was still on the waiting list in March 2008 when he fell ill and was diagnosed with tuberculosis (TB). He completed a six-month course of treatment, but the TB returned three months later and his health has not improved since he started the medication.

Paraziva's doctors suspect he has become resistant to one or more of the drugs he is taking, but there is no way of confirming this. Zimbabwe's public health sector has been in a state of collapse for months; government laboratories equipped to run drug sensitivity tests are not functioning, and most of the experienced laboratory technicians have left the country or moved into the private sector.

"I had been asked to take my sputum to the private sector but these tests are very expensive and I have no money," he said. "I am afraid I may not make it this time. I am not responding to treatment, but without the necessary tests they cannot tell which drug or drugs I am resistant to."

Many TB patients who depend on state hospitals for treatment share Paraziva's predicament. Zimbabwe's health system crisis, the result of years of underfunding and a political and economic crisis that has affected every sector of society, has all but wiped out TB control efforts; measures to contain and treat cases of drug-resistant TB, such as Paraziva may be suffering from, have been neglected.

According to the 2009 Global TB Control Report released on Tuesday by the World Health Organization (WHO), Zimbabwe has the fourth highest incidence of TB in the world. Unlike most other high-burden countries, which have been steadily improving their rates of diagnosing and successfully treating TB, Zimbabwe's have been declining.

Only 60 percent of TB patients diagnosed in 2007 were successfully treated, down from 68 percent the year before and well below the target of 85 percent recommended by WHO. Even more worryingly, only an estimated 27 percent of cases were diagnosed, down from 55 percent a decade ago.

The WHO report also highlighted a significant and growing gap between the cost of addressing Zimbabwe's TB epidemic and the money available to do so.

''I have been asked to take my sputum to the private sector but these tests are evry expensive and I have no money''
"The TB control programme has been adversely affected by a lack of adequate financial, human and material resources," the report noted. The country's recording and reporting system was also unable to provide reliable data for several aspects of the TB programme, including the management of multidrug- resistant TB (MDR-TB).

As in many sub-Saharan countries, the re-emergence of TB as a major public health problem in Zimbabwe is strongly linked to the HIV epidemic; an estimated 69 percent of TB patients are co-infected with HIV.

A grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria is expected to help revive basic TB control efforts, said the report, "However, without a functional health-care system, progress is likely to be slow."

Dr Owen Mugurungi, the National TB and HIV coordinator, told IRIN/PlusNews that in the context of the many challenges facing Zimbabwe, the country was doing its best to control TB.

"We have recorded cases of MDR [-TB] in Zimbabwe. The figures at national level are not yet available, but it must be noted that where resistance develops it is mostly because a patient fails to adhere to treatment and, as authorities, we can only go as far as counsel and stress on this issue," said Mugurungi.

"For MDR-TB, a patient is moved from first-line treatment to second-line, but this second-line treatment is very expensive and not readily available."

Paraziva, who never accessed second-line treatment, died on Tuesday, 24 March.

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