In-depth: The New face of TB: Drug resistance and HIV

MOZAMBIQUE: High HIV-TB co-infection could mean many cases of resistant TB

MAPUTO, 23 March 2007 (IRIN In-Depth) - Cases of extremely drug-resistant (XDR) tuberculosis (TB) could be going undetected in Mozambique, because the country lacks the capacity to diagnose it, health officials have warned.

So far, only one case of the deadly new form of TB has been confirmed by a laboratory in South Africa. A second suspected case has yet to be confirmed, according to the health ministry.

But in a country with more than 36,000 cases of TB every year, the number of people with XDR-TB could be much higher. In neighbouring South Africa, XDR-TB emerged in KwaZulu-Natal Province in 2006 and has since spread to other provinces, leaving more than 200 people dead so far, most of them HIV-positive.

The high number of HIV-positive people in Mozambique makes it an environment ripe for the rapid spread of XDR-TB: an estimated 16.2 percent of the country's population are living with HIV/AIDS.

When someone's immune system becomes compromised, for instance by HIV, people infected with the TB bacteria are likely to develop an active form of the disease or be more susceptible to infection.

The explosive growth of tuberculosis in slums

Photo: IRIN

BEIRA, TB cases are rising rapidly in the coastal town of Beira, according to local doctors. The city of half a million, which is the capital of Mozambique’s most HIV/AIDS affected province, logged 2,736 new TB cases last year, a 5 percent increase from 2005.  Full report

"There's no reason for panic," said Zaina Mutua Cuna, a TB official at the Ministry of Health. "We have a good TB programme". Officials are not alarmed yet, but say there is no room for complacency.

Cuna acknowledged that although Mozambique might have as many cases of XDR-TB as South Africa, having only one case was highly unlikely. Mozambique is one of 20 countries with 80 percent of TB cases worldwide, and almost half the people with tuberculosis also have HIV/AIDS.

Treatment interruption

TB is an airborne illness, primarily of the respiratory system, spread by coughing and sneezing, and the leading cause of death among people with HIV.

During the most infectious phase of TB - the first four weeks - a patient has to return to a medical centre every three days. "It's annoying, but it's necessary," said Maria Angelica Salomao, the TB official of the World Health Organisation (WHO) in Mozambique.

Patients who live far from health facilities are unable to come regularly, while others abandon treatment for other reasons. According to Salomao, seven percent of TB patients in Mozambique interrupt their therapy, which can lead to them developing multidrug-resistant TB, or even worse, XDR-TB.

Barbara Maccagno, medical coordinator in Mozambique for the international relief organisation, Medecins sans Frontieres (MSF)-Switzerland, told IRIN/PlusNews that the prevention of XDR-TB depended on early diagnosis, adhering to treatment, and the use of respiratory protection in high-risk areas.

"We were making progress, but AIDS came and complicated the effort to control TB," she commented.

Cuna, of the health ministry, said 42 healthcare workers had been trained to identify cases of resistant TB. The next phase of training will focus on community leaders, to enable them to encourage TB patients to stick to their treatment.

WHO announced in 2006 that US$95 million was needed to address XDR-TB in southern Africa in 2007 but, according to Cuna, Mozambique has yet to receive funding. "We do what is possible, and we keep trying to do better within our limits."

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This report is part of a PlusNews In-depth: 'The New face of TB: Drug Resistance and HIV'

The New face of TB Drug resistance and HIV March 2007 C O N T E N T S PDF file  Download this in-depth report 1.21 MB Lead Feature The days of TB complacency are over Features SOUTH AFRICA: XDR outbreak raises questions about TB SOUTH AFRICA: XDR-TB: is forced isolation the cure? SOUTH AFRICA: Joining the DOTS for a TB-free society SOUTH AFRICA: Hear Our Voices - "But how could it be TB?" KENYA: Drug resistant TB taking hold in urban slums KENYA: Hear Our Voices - "Without nutrition, drugs are useless in our bodies" LESOTHO: Deadly combination of TB and HIV MOZAMBIQUE: High HIV-TB co-infection could mean many cases of resistant TB In-Depth Feedback PlusNews welcomes feedback. Send your messages to feedback.

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