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Liberia’s TB Program Renaissance

-A Tale of MDR-TB Patient

“It’s just difficult that I will forget too soon how I felt when I was told that I had TB,” David (real name withheld), a man in his early 40s says. Tuberculosis (TB) is a disease caused by bacteria that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. In most cases, TB is treatable and curable if persons with TB do adhered to treatment. David says, “It was in 2015 when I got diagnosed and felt doubtful about my health condition, but later kept the courage in taking my drugs and injections.”

Being a commercial motorcyclist, David expressed the thought that he may have contracted the mycobacteria while riding bike. He believed his life met its end especially when he had completed an eight month regiment and was found to be a Multi-Drug Resistant Tuberculosis (MDR-TB) patient.

Drug resistance is more common in people who do not take their TB medicine regularly, or people who do not take all of their TB medicines as told by their doctor or nurse, and people who develop TB disease again, after haven taken TB medicine in the past, as well as, others who come from areas where drug-resistant TB is common, and/or have spent time with someone known to have drug-resistant TB disease.

“I was immediately put on bed due to my health complications,” David explained.

Following several months of taking his medication in time, David and sixteen (16) others were certificated for adherence and completion of their treatment during a well-organized program.

“I just can’t believe that I went through it all,” David spoke to the audience. “I am happy to be alive today. I am happy that I am among those who completed their treatment. It was a very difficult period during all stages of my treatment – the everyday tablets and injections. I am very proud to be part of the number, because leaving from TB stage to MDR-TB is like leaving from earth to hell. This success demonstrates how the doctors and nurses have been doing great job here at TB Annex. …I promise and call on all of us to serve as ambassadors in spreading the good news that TB can be cured. …Many thanks to our people who helped with our recovery, the doctors and nurses of TB Annex, Partners In Health and Global Fund,” David testified with smiles on his face during a program organized by the National Leprosy TB Control Program (NLTCP). The program was intended to increase awareness on the TB Program and to certificate 17 MDR-TB patients who had completed their treatment at the end of December 2017.

The NLTCP is an arm of the Ministry of Health (MOH), responsible for clinical TB interventions. The MOH is a Principal Recipient of the Global Fund to Fight AIDS, TB and Malaria (TGF) grant intended to provide free treatment, care and support services to persons living with HIV, TB and Malaria in Liberia. The NLTCP operates the TB Annex and provides equipment and supplies to other health facilities to assist in the “End TB Campaign.”

Mrs. Dedeh Kesselly, the Program Manager of NLTCP said there is plan underway to accelerate progress toward ending TB in the Country. She expressed how happy she was when the Program declared cured and discharged 17 persons who were MDR-TB patients. She expressed many thanks to the Global Fund and partners for their significant support to the National Program to end TB in Liberia.

“The struggle to end MDR-TB has been tough but we are making progress through the help of our partners especially, the Global Fund. With the advancement in TB treatment, I hope those to come after you will not stay long on treatment while at the TB Annex,” she said.

Outlining some achievements of the Program, Madam Kesselly said at the beginning of 2000, the NLTCP had established 450 Directly Observed Treatment, short-course (DOTS) centers, a name given to the TB control strategy recommended by the World Health Organization, 166 Microscopic centers, secured over 200 beds exclusively for TB patients and engaged 3,000 health workers (skilled and unskilled) for TB activities in both public and private health facilities nationwide. However, the 2014 Ebola Virus Disease epidemic drastically affected this situation leading to closure of many health facilities which did not meet Infection Prevention and Control standards. In 2015, there were only 182 TB Health Care Facilities and 64 microscopic centers providing DOTS and diagnostic services respectively in the country.

TB control is one of the health priorities in the MOH Essential Package of Health Services. TB control is integrated into the Primary Health Care (PHC) services under the coordination of NLTCP within the bureau of preventive health services of the Ministry of Health.

According to the National TB Program Manager, in 2016, WHO estimated the incidence of all forms of TB including HIV in Liberia to be 14,000 cases (308 per 100,000); and estimated incidence of HIV positive among TB cases was 2,200 cases (48 per 100,000)

In the same year, she said, of the 7,180 all forms of TB cases notified, 7,105 (98.9%) were incident TB cases (New and Relapse); of which 69% were had pulmonary TB and 63% were bacteriologically confirmed. With the incidence still high among the reproductive age.  Similarly, 77% of all the 6,147 incident TB cases notified in 2015 were successfully treated, while 65% of the 43 retreatment TB cases notified in the same year were successfully treated.

The annual TB mortality rate is still high. According to WHO 2017 Global TB report, 60 out of every 100,000-population died of TB among HIV negative TB patients while 21 per 100,000 population died among the TB/HIV co-infected patients in 2016. The impact of HIV epidemic on TB burden has influence on the outcome of treatment. The HIV zero-prevalence among the general population was estimated at 1.5% and about 4% from Antenatal Care (ANC) sentinel surveillance.

In 2016, 4230 (69%) TB patients were screened for HIV, 548 (12.9%) were HIV positive, 432 (78.8%) were on cotrimoxazole preventive therapy and 154 (28.1%) HIV positive TB patients were put on ART. The dual epidemic of TB and HIV threatens the gains made in TB control over the past years.

Meanwhile, the NLTCP has planned to identify about 313 (100%) of MDR-TB patients in 2018; 347 (100%) in 2019 and 377 (100%) in 2020, from 92 in 2016.  Increased treatment coverage was projected from 47 in 2016 to 162 (75%) of estimated MDR-TB patients in 2018, to 210 (75%) in 2019, and 225 (100%) in 2020.

 

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