Over the past two decades, the number of tuberculosis cases has risen worldwide, especially in developing countries of Southeast Asia and Sub-Saharan Africa, where co-infection with HIV is common.
Uganda, according to the World Health Organization (WHO), is ranked the 16th out of 22 TB burden-laden countries, having about 102,000 new cases per year. Since TB was declared an emergency disease in 2005, affected patients are increasingly becoming infected with HIV.
According to the National TB and Leprosy Programme (NTLP) data, 2010, a total of 45,546 people within the age group of 15 to 55 have TB and 54% of these are HIV positive. In effect, Uganda registers 52 deaths per 100,000 people living with HIV/AIDS to TB.
"People co-infected with HIV and TB are 50 times likely to develop active tuberculosis which kills quicker than normal TB compared to the uninfected," Dr Francis Adatu Engwau, the NTLP programme manager says.
Dr Engwau says the TB germ divides once every 24 hours spreading through all parts of the body, affecting mainly the lymphatic system, particularly the lungs. Because tuberculosis can spread through the air, the increase in active tuberculosis among people infected with both tuberculosis and HIV weakens their immune system putting them at a risk of death.
According to Engwau, people living with advanced HIV infection are vulnerable to a wide range of opportunistic infections because of weakened immune system.
"Tuberculosis is an HIV related opportunistic infection and a person who has both HIV and active tuberculosis has an AIDS defining illness," Engwau explains.
TB occurs earlier in the course of HIV infection than other opportunistic infections making it difficult to diagnose, progresses faster and is more likely to be fatal if undiagnosed or left untreated.
According to Engwau, people living with advanced HIV infection are vulnerable to a wide range of opportunistic infections because of weakened immune system.
"Tuberculosis is an HIV related opportunistic infection and a person who has both HIV and active tuberculosis has an AIDS defining illness," Engwau explains.
TB occurs earlier in the course of HIV infection than other opportunistic infections making it difficult to diagnose, progresses faster and is more likely to be fatal if undiagnosed or left untreated.
When a patient diagnosed with a strain of TB bacteria is resistant to two or more 'first-line' antibiotic drugs, the patient develops what is known as the Multi-Drug Resistant TB (MDR-TB). MDR-TB develops after one has been on first-line treatment for six to eight months.
This is when the patient changes to newer and often less widely-available 'second-line' drugs. Of the 870 MDR-TB cases Uganda has currently, 226 are living without drugs.
"Treatment with second-line drugs can take a very long time, and is usually far more expensive than standard Direct Observation Treatment (DOTS) therapy because most of the drugs are still under patent," Engwau says.
Treatment for an MDR-TB patient is estimated at about Shs 800,000 compared to the usual Shs 30,000 for a newly infected TB patient. However, some patients' bodies further resist second-line' antibiotics making them develop Extreme Drug Resistant Tuberculosis (XDR-TB).
"This condition may make it virtually impossible to formulate an effective treatment regime for them and many die before it is detected," Dr Eldad Mulumba, the TB zonal supervisor for Kampala says.
Although the government has dedicated 38 % of the health department's budget towards fighting the epidemic, little progress has been made towards curbing it.
Engwau attributes the problem to laxity in the private sector, inadequate resource allocation at the national and district level and low community participation in TB control activities.
To hit its target of reducing TB prevalence and deaths by 50% by 2015, Mulumba encourages government to empower communities with information for easy adoption of preventive measures against the disease.
Racheal Ninsiima
allAfrica.com