TB and war against HIV/AIDS

May 9, 2007

Ibrahim Umoru is a person living with HIV/AIDS (PLWHA). His fight against the dreaded scourge has been courageous and he is determined to live.

But Umoru has one fear. And that is the fear of tuberculosis, an opportunistic and debilitating disease that often infects PLWHA.

“I do not fear HIV/AIDS that has no cure. But I fear TB that has a cure but which kills faster than lightning and HIV/AIDS,” Umoru told an audience at an awareness seminar to mark this year’s World TB Day in Lagos. Medical experts estimate that 380,000 cases of TB are recorded in Nigeria annually, making the nation the fourth among the 22 countries afflicted with the disease.

It is a global phenomenon that is ravaging millions of people, with more than two billion, a third of the world population, infected by it. The disease mainly affects persons in their productive ages (25-44 years) with a negative impact on the country’s human development agenda.

The World Health Organisation (WHO) says an estimated eight million people worldwide get sick with TB, while it kills two million each year.

An undiagnosed and untreated patient, it adds, can infect between 12 and 15 persons annually. The disease is characterised by prolonged and persistent cough that may be associated with chest pain, breathing difficulty and coughing out of blood.

Because of its debilitating nature and the need to control it, the WHO declared March 24, as the World TB Day.

Nigeria celebrated this year’s TB day with the distribution of an estimated N 15 million worth of diagnostic and laboratory equipment and reagents.

The items, donated by WHO in conjunction with the U.S. Agency for International Development (USAID), were meant to assist the Federal Ministry of Health in checking the spread of the disease.

Presenting the materials, the WHO Country Representative, Dr Peter Eriki, said they would scale up early detection and treatment of TB in the country, using the Directly Observed Treatment Short-course (DOTS) strategy.

The DOTS strategy is credited to be the most cost-effective public health approach toward checking the spread of TB globally. This strategy has been successfully adopted in the treatment of more than 22 million TB patients in 183 countries since 1995.

Eriki said the gesture was in line with global and regional initiatives such as the Millennium Development Goals (MDGs) and the Global Stop TB partnership target. He said it was also aimed at meeting the African Regional Committee Declaration on TB as a Regional Emergency (Maputo Declaration), as well as the Abuja Targets for Universal Access to TB, HIV/AIDS and Malaria Services (May 2006), and the nation’s NEEDS document.

Receiving the materials, health minister Eyitayo Lambo emphasised the burden of TB in Nigeria, saying the situation was further worsened by its co-infection with HIV-AIDS. Nigeria is ranked third in global HIV/AIDS infection.

Lambo said it would probably increase the level of TB coverage and treatment from the current 30 per cent rate to the WHO’s recommended 70 per cent mark. “Currently we have the DOTS operations in Primary Health Care facilities in some 600 local government areas across the country.

“With these equipment, we should be able to cover the entire 774 local government areas with this effective and efficient approach to treatment of tuberculosis within the next two years,” Lambo said.

The ravages of TB are not limited to any particular locality. The Lagos State TB and Leprosy Control Officer, Dr Hussein Abdul-Razzaq, said a 2005/2006 survey in public health institutions showed there were more than 21,000 TB patients in the state. The state government, he said, had taken steps to control the disease, leading to an increase in the number of TB control programme centres from 11 in 2003 to 46. This is in addition to 31 diagnostic centres.

Dr Sulaiman Akanmu of the Lagos University Teaching Hospital said 3,370 TB patients were receiving treatment in the hospital. He said that 616 of the patients or 18.30 per cent were co-infected with HIV/AIDS. Akanmu, a consultant haematologist, advised that TB treatment should be accorded priority if the sufferer was also diagnosed with HIV/AIDS.

Global concern for TB is compounded by the high HIV/AIDS prevalence and its rate of co-infection with Tuberculosis. Statistics show that one-third of the more than 40 million PLWHA are co-infected with TB, majority of them in poor countries. For this reason, Akanmu suggested that the treatment of TB required strict and consistent treatment for between six and nine months, while HIV/AIDS required much longer period.

The WHO believes that an efficient and effective laboratory service will help Nigeria provide at least one sputum microscopy laboratory to every 100,000 population.

This is important because of the recent Multi-drug Resistance (MDR) threat or the Extensive Drug Resistant TB (XDR- TB) which constitutes a major problem, and is spreading fast in some parts of Africa.

“These equipment and reagents are to enhance performance in the 17 states as part of the overall strengthening of the health system within the framework of the ongoing sector reform.

“With this input, an estimated 350,000 TB suspects are expected to be screened, while some 35,000 smear positive TB cases are diagnosed,” Eriki said.

Experts say with adequate and regular treatment, the incidence of TB can be reduced drastically in Nigeria. But they also submit that one-fifth of the world population, including Nigeria, has yet to have access to DOTS services.

It, therefore, behoves the authorities to provide and administer the right medicaments to the victims, while ensuring that the theme of this year’s celebration, “TB anywhere is TB everywhere”, is taken seriously.

Fadu writes for the News Agency of Nigeria.