Ignorance, stigma failing TB-preventive treatment
Oct 31, 2023
“The dosage of TB treatment takes long. For example, some take three months, six, nine, and others 18 months," Ojambo says.
Shakirah Atuhaire
John Musenze
Journalist @New Vision
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When 25-year-old Shakirah Atuhaire, developed a cough, she thought it was a normal one until she started coughing blood for more than two weeks.
“I used to take Ampliclox tablets thinking this was the usual cough, but when I coughed blood, I rushed to Mulago [National Referral Hospital in Kampala]. It was from there that I learned that I had TB. I have not been told when my medication will end but I'm tired of taking drugs,” she says.
The resident of Matugga in Wakiso district has been on TB medication for two months.
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. Not everyone infected with TB bacteria becomes sick.
Just like Atuhaire, the barriers to TB preventive treatment are many, according to Dr Flavia Ojambo, a medical officer from Mulago National TB Referral Clinic. Ojambo says Mulago receives over 500 TB patients every month and that 46% of these are HIV-positive.
She, however, says ignorance about free TB treatment, lack of trust in the Government and the long duration of time prescribed to finish their dosage are some of the barriers to TB preventive treatment.
“The dosage of TB treatment takes long. For example, some take three months, six, nine, and others 18 months," Ojambo says.
"Also, the side effects from these drugs are a big barrier. Just like other drugs to a new body, some people vomit and feel weak which makes many stop taking these drugs," she adds.
According to her, TB drugs are very strong because, within two weeks, patients feel very fine, which causes some of them to think that they do not need to swallow the drugs anymore.
There is also a lot of stigma associated with TB patients, many people think every person who has TB has the wrong HIV
Key to solving the challenges
She suggested that the solution to these barriers is massive sensitisation, creating more TB awareness programs but also families of TB patients need to help, especially on stigma and adhering to the medication.
New research done by the International Union Against Tuberculosis and Lung Disease (Union) shows barriers to accessing TB preventive treatment remain in Uganda, even though coverage is high among many people living with HIV.
The ‘Evaluation of Adherence, Completion, Events for Tuberculosis Preventive Treatment (ACE TPT)’ study explores how TB-preventive treatment (TPT) can be improved for people living with HIV including children.
Initial findings indicate that the main reason for 91% of eligible people not starting on TPT was missed appointments and opportunities – 81% of people living with HIV already on antiretroviral therapy (ART) and 96% of people living with HIV now on ART (i.e. for less than one month), respectively.
The findings are based on data analysis and health facility monitoring from June to December 2022.
The study established that 90% of people living with HIV who were already on ART had been initiated on TPT by December 2022. Of those, 69% had completed treatment and 31% were still on TPT.
However, only 11% of people living with HIV, new on ART were on TPT in June 2022. This increased to 50% by December 2022.
The study enrolled 306 people living with HIV now on ART and 392 people living with HIV already on ART, aged 15 and over, across 12 health facilities.
John Paul Dongo, the director of the Union Uganda office, says: “Despite improvements, barriers still hamper TPT implementation. Continuous patient education would help address stigma and apprehension about TPT.
“An efficient medicine supply chain, wider roll-out of shorter regimens, streamlined patient flow, implementation of adherence monitoring, and timely follow-up of patients are important to improve TPT completion,” he adds.
“These results and lessons learned will help us to identify approaches to improve and strengthen the initiation, adherence, and completion of the TB preventive treatment for all people and children living with HIV in Uganda,” John Paul says.
Health Ministry Commissioner for TB and Leprosy Dr Stavia Turyahabwe says 91,000 Ugandans fall ill with TB every year, according to the 2022 TB estimates, 15% of these are expected to be children and about 1,500 are people who have drug-resistant TB type.
“Close to 250 Ugandans fall ill with TB disease daily and in 2021, Uganda lost above 12,000 Ugandans to TB-related deaths making it 30 Ugandans every day who die from TB,” Turyahabwe says.
In Uganda, TB mainly affects people between the age of 15-54 years which puts a big percentage of the population at risk of getting infected.
Turyahabwe says the health ministry has set up free treatment of TB in all government hospitals and cautions everyone that TB is curable and preventable only if those infected take full dosage but also those who are not infected to protect themselves
According to WHO, a total of 1.6 million people died from TB in 2021 (including 187,000 people with HIV).
Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV and AIDS).
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