African Woman and Child Feature Service

A promising new and innovative diagnostic test will now enable doctors to detect more people with drug-resistant tuberculosis (DR-TB), thus increasing the urgency to respond to challenges of the pricing and supply of DR-TB medicines.

TB has continued to be the country’s leading public health issue. The Ministry of Health says there are over 132,000 cases of TB, and the country has the 13th highest burden of the disease on the list of 22 high burden TB countries in the world. Further, this statistic places the country at the fifth highest burden in Africa. Although evaluation reports shows that Kenya is on the right track in the fight against TB with its national program  making it one of the first sub-Saharan African countries to meet the World Health Organization (WHO)  targets for detecting new cases as well as treatment success.

Consequently, according to infectious diseases report by USAID “the country continues to treat more and more TB patients each year. However, widespread co-infection with HIV -close to 48 percent of new TB patients- makes TB treatment difficult. While the number of new cases appears to be declining, the number of patients requiring re-treatment has increased.”

It is an experience that Tabitha Makau knows all too well, “when my husband visited a doctor due to a persistent cough, it took a bit of time before we could have definite results.”

She further says that when the results came back positive, her husband hid in the house for months because he was afraid of being stigmatized because one cannot suppress the persistent coughs associated with TB. I became the father and mother of our three children, and he became like a fourth child. It is a draining process taking care of a TB patient.

With the prevalence of drug- resistance TB (DR-TB) the country is facing more than it can handle.

According to a new report by the international medical humanitarian organisation Médecins Sans Frontières (MSF), DR-TB is on the rise, but less than 7% of 440,000 new cases each year receive treatment, and DR-TB kills 150,000 people annually.

Diagnostic challenge

Despite the fact that TB is highly contagious and requires swift medical attention, diagnosis has remained a problem.

“Patients have been stuck in a vicious circle – not enough people are diagnosed, and drug supply problems along with high prices stand in the way of putting more people on treatment,” said Dr. Tido von Schoen-Angerer, Executive Director of MSF’s Campaign for Access to Essential Medicines. “The low demand for DR-TB drugs has made the market unattractive for producers, which is reinforcing supply and price problems.”

It takes three months for a definitive TB diagnosis to be achieved with the existing testing machines and health practitioners have had to put a patient on treatment before a complete diagnosis can be achieved, meaning that the treatment is administered blindly.

Changing lives

The new machine referred to, as Gene Xpert will be able to detect DR-TB in three hours.

“The test is quick, as it provides results in just two hours. It also has good sensitivity – meaning that it gives a positive result if TB bacteria are present. Compared to the existing benchmark method of testing, this new test has a sensitivity rate of 90%, which is excellent for a rapid test,” expounds Dr. Francis Varaine, TB expert at MSF.

In light of these challenges, the development of a new TB diagnosis test has been received with excitement in the medical fraternity and amongst patients.

Although TB can be cured, the drug treatment is a rigorous process that takes a toll on the patient both physically and financially.

According to MSF, the treatment of DR-TB relies on old antibiotics, many of which have severe side effects, ranging from constant nausea to deafness, and must be taken as complex regimens – patients must take up to 17 pills every day for up to two years.

WHO has however approved new guidelines of combining these pills that is both cheap and more patient friendly reducing the number of pills that a patient can take in a day to three to four as well as the course of treatment.

New frontiers

Although the idea sounds patient friendly, the country is yet to explore this new frontier of knowledge.

The TB medication has not changed. The regimen for normal TB still goes to six to eight months while DR-TB goes for up to two years. Consequently, the duration remains the same and so does the combination of drugs.

The only new aspect to the fight against TB is the testing process which has been hailed as promising and that it is bound to save thousands of lives.

“Now that we have a new test that can detect DR-TB in less than two hours instead of three months, we’re going to see many more people who will need reliable drug supplies to get cured,” said Dr. Jennifer Hughes of MSF.

Each machine costs about 16 000 dollars but WHO has promised to negotiate a lower price for low and middle-income countries like Kenya.

A 24-month drug resistant treatment regimen can cost as much as 9325 dollars for a patient, 470 times more than the cost of curing standard, drug-sensitive TB.

This article was originally printed in the Reject Online Issue 45 ( Download PDF | Read it online )