It’s Time to End TB
Fighting the Double Threat
In the last week, the world has changed for all of us. But as we confront the spread of COVID-19, we also know that now more than ever, our work remains essential.
This World TB Day, we stand in solidarity with the health workers around the world, tirelessly working at the frontlines to provide for health for all. Based on our 30 years of work in the HIV/AIDS epidemic, we know that community engagement is absolutely vital for effective program implementation of patient-centered care and long-term success.
Worldwide, tuberculosis continues to be one of the top 10 leading causes of death. In fact, each year there are an estimated 10 million people living with TB around the world – and 4,300 people die of TB each day.
This is especially dangerous for people living with HIV. The link between HIV and TB is well documented: TB is the most common opportunistic infection in people living with HIV, and HIV is a leading risk factor for contraction of TB.
And the impact of HIV-TB co-infection can be even more dramatic in children – children living with HIV and TB have higher rates of death than those with TB infection alone.
Vulnerable populations like children, women and girls, and people living with HIV are disproportionately affected by infectious disease. This year, we’re raising our voices alongside the global health community to declare: #ItsTimetoEndTB.
We are inspired by the stories of courage of individuals who have overcome TB with the support of health workers around the world.
Finding Children with TB in Remote Kenya
Locating children infected with TB in Turkana County is particularly challenging. The average distance to a health center is 50 km—usually covered by foot.
Traditional homes are constructed of sticks and daub, with the family sharing a tight communal space, which magnifies the possibility of one family member transmitting TB to another.
According to Abraham, a community health volunteer with Catalyzing Pediatric Tuberculosis (CaP TB), a project funded by Unitaid and implemented by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), caregivers often confuse the symptoms of TB in their children for a normal cough. So along with facilitating TB screenings, community health volunteers use the home visit to educate the caregivers about the disease. They also help the households implement TB-prevention strategies, such as ventilating the home properly and developing a habit of washing hands frequently.
During a recent home visit to a mother who had tested positive for TB, Abraham held an education session and checked on all of the children, as they too could have contracted TB. He sees no apparent sign of TB in the household, but he makes transportation arrangements so that the children can be brought to the hospital to be screened for TB.
The combination of better diagnostic tools and community health volunteers means that almost twice as many children with TB are now being identified since the beginning of the CaP TB project.
Detecting TB in Children to Save Lives in Malawi
Mallita Chipungu was all smiles when she gave birth to twins Aisha and Idah. She already had two children, so with the birth of her twins, Aisha and Idah, she became a mother of four.
Shortly after giving birth, Mallita had a rude awakening when doctors explained her children were underweight. Mallita and her twins spent almost a month in the kangaroo ward for special, premature babies, although there was no meaningful improvement to their conditions.
Cough monitors—volunteers trained by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) to support clinics with the active screening of children for TB under the Catalyzing Pediatric Tuberculosis Innovations (CaP TB) project—recommended that Aisha and Idah be screened for TB.
“Using the Pediatric TB Intensive Case Finding Screening Tool, we noted some symptoms ranging from fever, night sweats, neck swelling and difficulties in breathing,” says Enock Saka, a cough monitor at Thyolo District Hospital. The twins tested positive for TB, and immediately put on treatment.
Now, Mallita’s twins are improving, thanks to the clinical team supported by the CaP TB project.
EGPAF works in collaboration with the Ministry of Health (MOH) through the National TB program to promote effective and innovative models of care to improve the detection and treatment of pediatric TB in Malawi.
It’s Time We Ended TB in Children
Along the southern shores of Lake Victoria, west of Kenya’s capital city, Nairobi, a middle-aged man walks into a facility – it has become his routine. His mission is to not only treat TB, the disease that once threatened his life, but also to protect his three grandchildren who are all below five years of age.
Since December 2019, 59-year-old James Omollo has made 11 two-hour roundtrip visits from his home in Rusinga island to Mbita Sub-County Hospital in Homa Bay. James now joins the 58 million people that TB treatment saved between 2000 and 2018.
“When I was first diagnosed with TB in December 2019, I was very ill and famished,” James reveals, “I was coughing night and day and did not have an appetite.” James lives with his grandchildren, and knowing he had TB made him fearful of infecting them. “I did not want my grandchildren to go through what I went through,” James says. When he learned he could protect his at-risk grandchildren, James did not hesitate to bring them to the facility.
“Whenever we find an adult with bacteriologically confirmed infectious TB, we do household contact screening to identify exposed children and protect them from developing TB disease,” says William Ochieng, a Clinical Officer for TB and HIV at Mbita sub-county hospital. Mbita hospital is piloting a new treatment regimen for pediatric TB, which is more effective and can be completed in less time.
James’ grandchildren are among those who have completed the new shorter TPT regimen and all are thriving.
A Family Staying TB-Free, Together
In 2019, Buang was diagnosed with TB for the second time. She started experiencing chest pains and tiredness; she also had no appetite and had lost weight. She visited the nearby facility in the outskirts of Maseru, Lesotho, called Loreto, and consulted a healthcare worker for assistance.
Buang Rampitsana, 39, first contracted TB in 1992 and was treated and cured. She knows her HIV-positive status, and she has been on Antiretroviral treatment since 1996.
After Buang tested positive for TB and was treated, a health worker named Manapo Makubakube conducted a home visit to Buang’s family to see if any other family members had contracted TB. Buang’s husband was screened, and was not found to have TB. But their two children were experiencing flu-like symptoms, and one had a prolonged cough.
Results from the laboratory confirmed that Buang’s son, Motlatsi, had active TB. The child was given a two-weeks dose of treatment to start with, and asked to come back again after two weeks to monitor his condition and to refill the treatment.
After two weeks, Motlatsi came to the facility and was doing well, with no cough. He was bubbly, and smiling at everyone. Motlatsi was progressing well and he was given one-month refill for his treatment. His parents were instructed to return the next month for monitoring.
Grandpa David Keeps his Family TB-Free
David stands tall and strong. As a grandfather, he cares for more than 25 children either directly or indirectly. He cannot count the amount of money he has to come up with for school fees every time the academic year starts—yet he pays close enough attention that he realized when his little grandson Robert was unwell.
Robert had been coughing for several months. When David saw how much weight he had lost, he rushed him to the Rwashamaire Health Center (IV), which is supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) through the USAID RHITES-SW project and the CaPTB project by UNITAID. Robert tested positive for TB and was started right away on an anti-TB drug therapy. Fortunately, his recovery was speedy.
But that was not the end of the matter. The health center staff asked Grandpa David who else in the family was coughing and they made an appointment to visit the family home. David remembered Auntie Rose and her persistent cough. She also tested positive for TB. Now Robert is TB free, back in school and – Auntie Rose is doing better.
Through the USAID RHITES-SW project, EGPAF is at the forefront of the battle against TB in Uganda. Only about half of pediatric TB cases in southwest Uganda were detected in 2018. This is why we are working with clinicians to become confident in diagnosing and treating TB in children effectively.
The Courage to Fight TB
Simão Muangane, 58, knows firsthand how difficult it can be to keep up with a TB treatment plan. He has been on treatment for multi-drug-resistant tuberculosis (MDR TB) since September 2018, with support and monitoring from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF).
“One must have courage to comply,” Simão shares. “I had the support of the nurses; they even gave me their personal contact details, so I could call if I needed help. Still, when I stopped coughing, I stopped taking medications and going to the hospital.”
Soon, things took a turn for the worst: “I fell ill shortly thereafter: fevers and flu, plus a severe cough. So, I returned to the health clinic, where I took some medical exams and had a counseling session with the psychologist before restarting treatment. Since then, I have stopped coughing. I also got my appetite back and, this time, I am going to continue till the end.”
Team EGPAF
Global
General
