Integrated Regional Information Networks - February 28, 2012
NAIROBI, 28 February 2012 (PlusNews) - The Kenyan government's
recent failure to adequately treat a patient with extensively
drug-resistant tuberculosis (XDR-TB) has some civil society
organizations questioning whether the country's TB programme is
equipped to diagnose and treat such patients.
In October 2011, an HIV-positive Nairobi woman was diagnosed with
XDR-TB while receiving her treatment at the Kenyatta National
Hospital for multi-drug resistant TB (MDR-TB). Treatment was
provided by the hospital; however, she was prescribed three
additional medicines that she had to buy herself, to supplement
According to Allan Maleche, coordinator of the Kenya Legal and
Ethical Issues Network on HIV and AIDS, KELIN, following a public
outcry over the handling of the patient's case, the government
has stepped in to pay for all her medication. But Maleche warned
that more still had to be done.
"The government needs to have a policy that outlines clearly how
it will deal with cases of XDR-TB because at the moment that is
missing. The government must also invest in the treatment and
care of XDR-TB patients in Kenya," he told IRIN/PlusNews.
MDR-TB is resistant to the two most powerful anti-TB drugs, while
XDR-TB is resistant to these and at least two others. XDR-TB
patients, who pose the greatest public health risk, are also the
most difficult to treat. It costs about US$35,700 to treat a
single case of XDR-TB per year and the treatment normally runs
between 24 and 36 months.
"We have so far received only three cases of XDR-TB. Two have
since died and one is on treatment. But it is difficult to say
the exact number of such cases out there because no study has
been done to ascertain this," said Joseph Sitienei, director of
the National Leprosy and TB Control Programme.
There more than 500 known cases of MDR-TB in Kenya, and only 230
of these are on treatment, but activists warn that more cases
could be going undetected.
The government admits the TB programme in Kenya has not been
adequately funded despite the country's big TB burden. Kenya
ranks 13th on the list of 22 high-burden TB countries in the
world and has the fifth-highest burden in Africa.
"The resources that are available... cannot cope with the burden
of the disease as it is today. It is important to remember there
are other health concerns competing for the little resources
available," Sitienei told IRIN/PlusNews.
"We are looking for resources to enhance our capacity to deal
with cases of both MDR-TB and XDR-TB in order to buy medicines
and we are currently in the process of setting up a state of the
art isolation ward at Kenyatta National Hospital. But as of
today, individual health facilities have some sort of isolation
wards that can be used from time to time," he added.
Another major challenge is that TB patients either report late to
health facilities for diagnosis or default on their treatment,
increasing their chances of developing drug-resistant TB.
Sitenei admitted that TB surveillance had to be improved, as the
screening of MDR-TB patients for XDR-TB is "lacking".
"The government will also be training health personnel to be able
to adequately do the screening... at the moment, we don't have
the capacity to adequately do the screening."
TB is the biggest killer of people living with HIV. The Kenya
National AIDS Strategic Plan 2009-2013 notes that despite the
fact that 80 percent of TB facilities provide HIV testing, just
about 27 percent of HIV-positive TB patients receive
"The government has a policy to integrate TB and HIV programmes,
but a lot still needs to be done to realize success. Health
workers must be continuously sensitized on the need for the
integration of care and treatment of the two diseases," said
Nelson Otuoma, coordinator of a local lobby group, Network of
People living with HIV/AIDS in Kenya.