MOZAMBIQUE: Winning small victories against HIV and TB

Tete, 29 September 2008 (PlusNews) - Inês Muterua, 29, lies on a frayed straw mat between two mud huts and places an old tin can full of sand by her side. "I usually spit my phlegm into this can to keep from spitting just anywhere and contaminating others, like what happened with me."

Muterua contracted tuberculosis (TB) in October 2007 while taking care of her mother. After she died, the young woman was advised to take a TB test, which came back positive.

She lives with her husband and two children in Sansão Mutemba, a suburb in the city of Tete, capital of Tete Province in western Mozambique. The houses in the overcrowded neighbourhood are largely made of mud and hygiene is poor: factors conducive to the transmission of TB.

"There is a large portion of the population that lives without healthy hygienic conditions, and this facilitates the spread of the bacillus that causes TB," said Luís Cumba, the provincial health director.

In 2007 Tete Province registered 2,432 cases of TB; in the first trimester of 2008 the provincial health department registered 616 cases, but the actual number is believed to be higher, as many people do not come to health centres.

Although all the 110 health facilities in Tete Province can treat TB, most cases are referred to the provincial hospital, where TB is the third most common cause of visits, after malaria and AIDS.

According to the Ministry of Health, half the TB patients in the city of Tete are also HIV positive. TB is the most frequently occurring opportunistic infection in people living with HIV, and one of the most dangerous if not diagnosed and treated in time.

The province has an HIV prevalence rate of 14 percent in a population of around 1.4 million people, by comparison with an average national infection rate of 16 percent.

Drug resistant TB a growing threat

Muterua is HIV positive and takes antiretroviral (ARV) medication every day, but since she discovered she has tuberculosis, her treatment has included 16 more pills and a daily injection at the health centre.

In Mozambique, tuberculosis treatment is based on the Directly Observed Treatment Short-Course strategy (DOTS) recommended by the World Health Organization (WHO), in which patients are monitored to ensure that they take their medicines daily and at the correct time.

"I live a 30-minute walk from Tete Provincial Hospital and I have to go there early every day to take my medicine," said Muterua. Despite the complexity of the therapy, she has not missed a single appointment.

The cost of missing an appointment can be high: multidrug-resistant TB (MDR-TB) is on the rise in southern Africa, particularly in neighbouring South Africa. MDR-TB is often the result of TB patients failing to finish their course of drugs, and is particularly dangerous and difficult to treat in people living with HIV.

We fear that the cases of resistant TB will skyrocket ...which is why we are monitoring and carefully following the only two cases we've officially registered.

Even more disturbing has been the emergence of extensively drug-resistant TB (XDR-TB), a particularly virulent strain of TB that has left more than 200 people dead in South Africa.

The capacity to test for XDR-TB is practically nonexistent in Mozambique; so far, only two cases of the deadly new form of the disease have been reported in Tete, but officials have warned that the number could be higher.

"We fear that the cases of resistant TB will skyrocket ... which is why we are monitoring and carefully following the only two cases we've officially registered," said provincial health director Cumba.

Sticking to the treatment

Tete's health department has been conducting awareness campaigns about the benefits of taking TB medication and the dangers of failing to finish the six-month course, with some success.

"The number of pills and the long period of time over which they're administered used to affect the campaigns negatively, but now we've begun to obtain results," Cumba noted.

In many cases, the patients used to abandon treatment when they began to show signs of improvement, while the long distances to the health facilities were another discouraging factor.

In order to reduce the rate of interruptions, the provincial health department relies on trained community activists, who can identify new patients and also go out in search of those who fail to show up for appointments.

The province's TB cure rate of 32 percent is still low, and the goal is to raise this to 75 percent by the end of 2008. Mozambique is one of the 22 countries that have 80 percent of the world's TB cases.

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Theme (s): HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]