Eliminate drug abuse among HIV/TB patients

Jun 26, 2018

Currently, the World Health Organisation report indicates that the incidence of HIV+TB only in Uganda stands at 131 people per 100,000 people. In case these people abuse any drugs, their lives are in danger.

By Annet Nakibuuka

The world is commemorating the International Day Against Drug Abuse and Illicit Trafficking, today June 26, 2018. The observance was instituted by United Nations General Assembly Resolution 42/112 on 7 December 1987 to campaign against illicit drug trade. This means a lot to People living with HIV and Tuberculosis, along with their caretakers.

These drugs increase the risk to death among the said groups. Research has showed that there is a high co-morbidity (read ill health/injury) between substance abuse and tuberculosis. This even worsens when it comes to those who are HIV positive. 

Currently, the World Health Organisation report indicates that the incidence of HIV+TB only in Uganda stands at 131 people per 100,000 people. In case these people abuse any drugs, their lives are in danger.

As we partner with the United Nations to achieve the third Sustainable Development Goal (SDG) of ensuring healthy lives and promote well-being for all at all ages, particularly by reducing some of the common killers like tuberculosis and the spread of HIV/AIDS, there is need to address many different persistent and emerging health issues like drug abuse.

The drugs in question include alcohol, opioids, cocaine, cannabis, methamphetamine and nicotine among others. They have common features thus the terrible consequences as far as respiration is concerned.

Substance abuse is the most commonly reported adjustable behavior impeding TB elimination efforts in Uganda and world over, particularly among PLHIV. Rates of TB also remain high among homeless persons, and those who use illicit drugs. Majority of tuberculosis patients report abusing alcohol or using illicit drugs, and these appear more contagious and difficult to treat.

This is a result of drug addiction, the incontrollable use of a drug that can cause brain changes. It may lead to developmental, chronic medical, psychological and social consequences. Nevertheless, these are preventable, though hard to treat or regress.

Uganda is one of the first 25 countries with the highest TB burden (HBC) yet infection with the HIV has been the mostly associated risk factors for TB diseases in most HBC. The World health organisation TB profile for Uganda revealed that in 2016, there were 18225 new and relapse TB patients who were HIV positive (43%) in care, and of these, 16403 (93%) were on antiretroviral treatment. 

All people, especially those living with HIV/TB ought to stop drug abuse as it leads to poor treatment adherence, decrease in economic and social status, can result in unemployment, criminality and imprisonment, cramped living conditions, a high risk of infectious diseases as well as respiratory complications. These conditions are not favourable to a PLHIV/TB because they easily contribute to a body's wear and tear.

Largely, among TB patients, illicit drug use causes delayed diagnosis, promotes difficulties in identifying at-risk contacts and one is less likely to be screened for TB. Also, while there may be less access to routine medical care, it is difficult to treating patients with positive findings (poor adherence).

Not only that, but TB patients abusing drugs tend to become more contagious, and are less likely to complete treatment for latent infection or active disease. The reason is simple: drugs Compromise their immune systems yet Anti-TB meds are usually metabolised by the liver, which is often damaged by the substance.

Drug addiction is a complex but treatable condition that affects brain function and behavior.  Although no single treatment is appropriate for everyone, effective involuntary treatment should be adopted. Medications are an important element of treatment for many patients, and so, medical detox should be the first stage of treatment.

Remaining in treatment for an adequate period of time is critical for treatment effectiveness, coupled with counseling and other behavioral therapies. Treatment programs for HIV/AIDS, Hepatitis B & C, Tuberculosis (first and second line) and other infectious diseases should be handled with extra care so as to help clients modify at-risk behaviors. 

Therefore, we are mandated to accept and follow the Geneva 2008 policy guidelines for collaborative TB and HIV services for injecting and other drug users, if we are to achieve our goal. These include, Continuous Multi-sectoral coordination at the local and national levels to plan, implement and monitor TB and HIV activities for drug users, the national strategic plans for TB, HIV and substance misuse to clearly define the roles and responsibilities of all service providers, as well as efficient and effective implementation of collaborative TB/HIV activities with a TB infection control plan. 

 Further, TB and HIV services for drug users should ensure access to appropriate treatment, and all health services should ensure access to preventive therapy for drug users living with HIV, once active TB is reasonably excluded. Finally, all personnel working with TB suspects and patients, people living with HIV and drug users should be able to assess risk factors for HIV infection and transmission and should provide comprehensive HIV prevention information and services.

Together we can end TB.

The writer is an HIV activist

















 

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