Drug-resistant TB costly to treat

THE cost of treatment of extensively drug resistant tuberculosis (DR-TB) in Zimbabwe is estimated to be as high as $31 000 per patient, hence the need to nip it in the bud before a person develops it.

By VENERANDA LANGA

According to a report by the Parliamentary Portfolio Committee on Health and Child Care presented last Thursday, it is high time tuberculosis (TB) is placed high on the political agenda in order to ensure there is political will to fund TB treatment and interventions in the country.

Currently, TB treatment funding is from the government, supported by the Global Fund and other partners.

Lesotho 2010 MDRTB Patient 620x350 TB can become drug resistant if patients fail to take medication as prescribed. [CAPTION]

Zimbabwe is said to be one of the countries highly burdened by TB due to the HIV epidemic where HIV prevalence among the 15 to 49-year age group is 15%.  The current estimation of TB prevalence is 345 people per 100 000 and there is also 69% HIV co-infection in all TB cases (Global report 2014).

Although all types of TB are a worry, the committee said what is more worrisome is DR-TB which is difficult to cure and is a result of a patient defaulting in taking TB medication.

DR-TB (drug resistant tuberculosis) in medical terms is said to be caused by a bacterium (Mycobacterium tuberculosis) that has developed a genetic mutation (s) such that a particular drug (s) is no longer effective against the bacteria.

An outline of treatment of TB in Zimbabwe and its costs shows drug susceptible TB costs $31 for a course of six to nine months.  Multi-drug resistant TB is said to be treated with a course of medication taken for 20 to 24 months and costs $2 571 to treat a sufferer, while extensive drug resistant TB takes 24 to 36 months to be treated at a cost of $31 000 per person.

“In this regard, with the economic strains facing the country, prevention and control of the disease is key to TB management in the country,” Emakhandeni/Entumbane MP Dingilizwe Tshuma said in the National Assembly while presenting the Health Committee report on TB.

“It has become imperative to note that the TB disease mostly impacts people in the prime of their lives, from age 15 to 50, decreasing their ability to contribute to their country’s economy and to support their families.  In this regard there is need to have a broad set of coordinated interventions designated to place TB high on the political agenda, foster political will and increase financial and resource allocations,” Tshuma said.

The Health committee said the media must support TB prevention through audio, video and printed stories.

Some of the challenges being faced by hospitals in the detection of TB were said to be weak laboratory and detection systems.

“The staffing levels are low, and there is skills flight that has resulted in staffing levels at 54%, which is a worrisome situation.  The remaining staff is overstretched, and generally there is inadequate funding for most activities.  There are challenges in infrastructure, with some laboratories constructed before independence, which does not conform to current international standards.”

Other challenges were said to be obsolete equipment with recurrent breakdowns that are expensive to maintain, as well as donor fatigue with most activities either being scaled down or closed totally.

As recommendations, the committee said the Ministry of Health and Child Care must as a matter of urgency include in the 2016 budget the use of mobile clinics so as to improve access to early diagnosis, early initiation of appropriate treatment and monitoring and evaluation of the treatment response.

“The Ministry of Health and Child Care must ensure that National Pharmaceutical Company of Zimbabwe is allocated adequate funds in the 2016 budget to be able to facilitate the continuous availability of drugs. This would reduce new strain of tuberculosis called Multiple-Drug-Resistant-Tuberculosis which is expensive and difficult to manage.”

Chairperson of the committee Ruth Labode said multi-drug-resistant TB is frightening and costly, hence the need to ensure people diagnosed with TB are treated and finish their course.

“We have to urge our relatives and people in the constituencies to take their tablets on a daily basis. Why are people defaulting? They are defaulting because TB drugs cause gastritis. You need food to take them and people do not have food but the danger of that is we cannot afford the other side of expensive treatment.”

Labode, who is a medical doctor, said when she used to work at Thorngrove TB Hospital in Bulawayo people were given beans, cooking oil and other food handouts to ensure they had a good diet while taking their tablets.

“The danger is that, it is not only those who work in the mines that will get TB, even among ourselves, people of my age (old) and those with diabetes can get multi-drug resistant TB. Some of us will catch it and die because only 50% of the people with DR-TB actually are healed,” Labode said.

She said DR-TB is more dangerous than HIV because it changes its shape in the body and becomes something else.

“One of the things that create a problem is our TB is 100% funded by donors, but our problem is that the distance patients have to travel is too long.  For a patient who needs $5 for transport to get TB drugs but they do not have the money, they end up defaulting in taking the drugs and they end up breeding DR-TB,” she said.

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