Nigeria: 'Over 3000 persons living with multi drug resistant TB'

What exactly does the institute do, I mean it's mandate?

Institute of Human Virology in Nigeria (IHVN) is a nongovernmental specialised institution, focusing on diseases that are of public health interest. We started in 2004 implementing a grant from the University of Maryland, USA, and our mandate then was to support the federal government in implementing the response to the scourge of HIV/AIDS. Then the picture and presentation of HIV/AIDS is totally different from what it is today.

In 2004, one of the clear issues related to HIV/AIDS was that it was more a terminal illness even though there was treatment available. You go to hospitals, there was quite a lot of waiting list and people were dying. Federal Ministry of Health had already commenced some activities, but they were limited by scope in terms of funding and technical support to those sites.

We started in six sites, supporting prevention, care and treatment in three states. Today we have been providing services in HIV/AIDS in about 23 states. There is now a push toward streamlining, rationalising implementing partners within the US government's PEPFAR programme--that is identifying partners that will focus in particular states. IHVN is now focused in nine states and we are supporting another implementing partner in one state to scale up services.

HIV has a twin in terms of infection--tuberculosis. HIV/AIDS suppresses immunity of a person and as a result the person becomes susceptible to infections--one of those is tuberculosis. As we provided HIV support, it was very clear we needed to do a lot in support for TB. Since the same person with HIV has TB, you can't separate them. So we decided not only to provide support in training and personnel, equipment and standard operating procedures but also diagnostics.

We commenced support of the National and Leprosy Training Centre in Zaria, by expanding their curriculum for TB to include HIV. All staff coming from primary health care centres that provide TB DOTS - Daily Observed Theraphy services will also be able to diagnostic HIV and provide palliative care.

We also piloted the fluorescent microscope, a technique that improves the detection of TB more than what the conventional method does. We moved on to establish a TB culture lab. There are two in Zaria--one is a solid culture with a safety level graded as 2, the other is a liquid culture lab with safety level graded as 3. It is very sophisticated.

We also introduced molecular diagnostics in the diagnostics of TB. As a result of our activities in this arena, we were qualified to apply for the TB grant when the Global Funds advertised need for a principal recipient for TB, focused on multidrug resistant TB. We joined as one of five principal recipients in the country. There are two principal recipients on TB but our own role is to focus on ensuring multidrug resistant TB prevention, diagnoses and treatment is adequately addressed by the country.

We also have partnered with National Agency for Control of AIDS as sub recipients for HIV scaleup in the country, and with the National Malaria Control Programme as sub recipients for providing support for malaria diagnostics and treatment and prevention.

What's the prevalence of multidrug resistant TB?

The burden now is estimated at almost 3,000 people living with the multidrug resistant strain of mycobacterium TB. The prevalence among TB cases is about three and five percent, and varies. But 3,000 is quite a lot, because right now we have less than 400 people on treatment. The gap is quite wide, and so we are looking forward to getting additional resources to ensure we have additional diagnostic centres; there is the easy equipment called the GeneXpert being scaled up. It detects resistance to one of the drugs and tells you the person has resistant TB. Expanding the detection is one mandate. Second is if you detect them, you have to place them on treatment. Not all venues can provide MDR treatment, but we are working with the federal and state governments to ensure there are additional treatment centres across the country.

What is responsible for the multidrug resistant TB?

Like most other infections, inadequate treatment is responsible. But there are primary resistant TB strains. When somebody who already has resistant TB spreads the infection, whoever is getting it gets a strain that's already resistant, even though it is new to them.

Nigeria has adopted DOTS--Daily Observed Therapy, where you observe the intake of the TB drugs on daily basis. Some volunteers or health workers have to watch the person take the drugs just to enable the patient continue therapy. It doesn't happen all the time. So when you default on treatment, you are on and off, the bacteria is not getting the optimal dose, it becomes resistant. That's extra burden of treatment. To treat MDR TB takes up to 18 months. (Ordinary TB takes six to nine months). Even the time factor alone tells you the cost is quite huge.

Do we know how much of multidrug resistant TB comes as primary resistance or from inadequate treatment?

Those that get it primarily, it is about 3%, while among cases on treatment it is close to 12%.

How effective have the sites been at treating MDR-TB and how effective has collaboration been with states?

The effort to ensure proper treatment has come as a result of a lot of partnership. Currently IHVN works with the TB and leprosy control programme of federal ministry of health, which provides guidance and coordinates all activities that are going on. The World Health Organisation has a key role as well as the Centre for Disease Control, USAID and the Damian Foundation.

The sites have been very excellent response. Where TB treatment has been established, the dedication of staff is very unique. People have been discharged to continue treatment at home, and hospital staff have followed them up to ensure they stay on track.

More states are requesting for technical support to establish centres. That tells you we are moving toward sustainability of the programme. Our hope is that we don't have TB but now that it is there, we want a situation where it can be treated within normal health care system, not depending on donors.

More young people are getting diagnosed with TB. Are the demographics of TB typically changing?

Gender is not significant, both males and females are affected. But age--TB is airborne and you find the younger people are more active, so within age 20 to 35 years, it is common. But even newborns can get TB.

Are the youths among the 3,000 cases?

I will talk more of those on treatment. Among them, about 70% of them would be between the ages of 20 and 35. TB prevalence has gone up as a result of HIV, and if you look at it that way, you will find that the demographics of HIV will be similar.

How much did IHVN get from Global Funds, and where will you be using it?

The grant we signed--to end 2015--is $11million. It is going to be used to scale up treatment and put in additional treatment and diagnostic centres to support close to 700 patients on therapy. It is pretty expensive--one, we will pay for the drugs; two, we will provide support for patients because they will be on admission for a whole year without working and we support them with food and small expenses while they are in hospital. We also pay for their drugs and all the monitoring. We are also expanding infrastructure for diagnostics--one lab at Jos University Teaching Hospital, another in the south east, and partnering with other partners to support additional diagnostic centres.

We are more patient driven than site driven--in the sense that even if we establish x number of diagnostic and treatment centres, if we have not treated this number of patients, we haven't achieved anything. So we leverage the money for what is required for patient care and then work with government for structure and equipment. Otherwise the money will end up in structure and the patient will not get any drug.

So far how many patients do you have on treatment?

About 320.

Source: allAfrica.com