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Integrate Care to Fight TB

On July 4, 2004, Nelson Mandela issued a call-to-action to world leaders:

“The world has made defeating AIDS a top priority. This is a blessing. But TB [Tuberculosis] remains ignored. Today we are calling on the world to recognize that we can’t fight AIDS unless we do much more to fight TB as well.”

Mandela was speaking at the XV International AIDS Conference in Bangkok, Thailand. He wanted to bring to light the plight of millions of people with HIV who were at increasing risk due to the spread of TB.

Coincidentally, this speech was made just ahead of the birth of Dignitas International, a non-governmental medical and research organization (NGO) dedicated to the fight against HIV and related conditions. Today, Dignitas is marking a decade of leading the way in providing integrated TB-HIV care for people in Malawi.

Kelvin Phiri, a fisherman at Lake Chilwa, is one of their champions. Kelvin was recently diagnosed with HIV, the virus that causes AIDS. Last month, he was struggling with a stubborn cough. He hopped on board a pickup truck and travelled more than 30km to Zomba Central Hospital. Kelvin was directed to Tisungane Clinic, the clinic set up by Dignitas in collaboration with the Ministry of Health in 2004.

“When I arrived, health workers told me that I was HIV positive and that I had tuberculosis (TB). I was immediately admitted to the hospital where I have spent the last 14 days,” Kelvin explained as he sat in the TB registry.

The health centre near Kelvin’s home village does not have the tools needed to test on-site for TB. Instead, sputum samples are collected regularly and sent to Zomba Central Hospital for testing. As such, Kelvin and others like him have to travel long distances to access the services.

At home, most of the people in Kelvin’s community depend on fishing in Lake Chilwa for survival. Unexpected medical costs are difficult to manage.

“Right now, the Lake is officially closed for fishing the smaller fish. I am lucky because I catch the bigger fish and am able to continue supporting my family,” said Kelvin.

He travelled to Tisungane Clinic where the diagnosis was confirmed and he received treatment for both his HIV and TB. It was a one-day trip thanks to the integrated care set-up where both HIV and TB are treated under one roof at Zomba Central Hospital. Tackling HIV and TB in tandem is exactly what Mandela was advocating for. Dignitas has won a small battle in making this possible with the integrated TB-HIV clinic at Zomba Central Hospital.

Harriet Akello is the Tisungane Clinic Coordinator and oversaw the move of the TB-HIV Clinic to the newly refurbished rooms where maximum ventilation ensures reduces the risk of transmission.

“We encourage people to get tested for TB and to start treatment as soon as possible,” said Harriet. “Due to a weakened immune system, people with HIV are more likely to die of TB than those without the virus.”

Zomba Central Hospital is the only tertiary level referral hospital serving more than 3 million people in the South Eastern region where lakeshore communities are hotspots for HIV/AIDS and TB. According to the Ministry of Health, for every 100 TB patients, approximately 64 have HIV.

Clinic nurse, Agnes Jusu, oversees the ART dispensing in the TB-HIV Clinic.

“We collect sputum samples for laboratory testing to determine if a person has TB. We also provide TB drugs and advise patients on how to take them,” outlined Jusu. “Patients sometimes need extra support to understand that it is safe to take both ARVs and TB drugs at the same time. They get detailed information about side effects and when to check back at the clinic.”

More integrated TB-HIV clinics like the one at Tisungane Clinic in Zomba will significantly strengthen the medical forces fighting the dual epidemic. With support from USAID, Japan’s Izumi Foundation and others, Dignitas is preparing to set up additional integrated clinics in the districts of Balaka and Machinga.

On March 24th, people around the world commemorated another World TB Day with a theme focused on access to a “TB test, treatment and cure for all”. Globally, nine million people each year contract TB but 3 million do not have access to treatment or care. As we look to the year ahead, let’s reflect on Mandela’s wisdom and continue the fight.

(Adapted from an article featured in the Malawi Nation on March 24th, 2014)

Dignitas InternationalIntegrate Care to Fight TB