Uganda: New TB treatment in relation to HIV
The world conference on TB and chest health opened in full gear in Lille France, with a keynote presentation by the executive director of the Global Fund to fight AIDS, TB and Malaria, Prof Michel D Kazatchkine.
The international meeting, which brings together doctors, researchers, scientists, advocates, and interested groups from over 120 countries, re meeting for three days to discuss lung health and especially tuberculosis.
TB is a contagious disease which spreads through the air. Most people who get infected never develop the disease. But with compromised immunity, especially in communities characterized by malnutrition, sickness, and poverty, it spreads very fast. Left untreated, each person with TB disease can infect bout 10 - 15 people every year.
Ugandans who presented at the conference were mainly in the posters area. Five doctors and a biomedical scientist displayed their research and were available to defend the studies before their colleagues.
1. Dr William Worodria, Consultant Physician at Mulago Hospital.
The question of starting TB patients who have HIV on ARVs.
Dr Worodria did this research as part of his course work for a PhD. He studied 254 patients with TB who were diagnosed with HIV and started on ARVs at Mulago Hospital TB-HIV clinic. Whenever a TB patient is started on ARVs, the body reacts and it is possible to think that the patient has got worse. This is known as Immune Reconstruction Inflamatory Syndrome (IRIS).
"TB breaks down the immunity of a patient but when ARVs come in, this immunity is awoken to recognize the two invaders, TB and HIV and start fighting. To fight better, the immunity cretes certain conditions that manifest as symptoms in a patient and seem like the patient is getting worse. We studied IRIS and monitored how long this happens till the symptoms disappear and the patient regains his health to recommend on whether it is wise to put TB patients on ARVs."
The study shows that 53 patients (21%) developed IRIS as soon as they were put on ARVs. Five of these (10%) died although there were other co-factors like diarrhea and pneumonia. The rest took two weeks to recover on average. Severe IRIS can take two months.
"Our conclusion is that to save lives, patients of TB should be started on ARVs in spite of the IRIS. 85% of the patients on our study survived."
Worodri says IRIS symptoms include gland swellings and some develop pus, the chest X-ray looks worse, the patient develops abscess and fluid in the chest and abdomen. "Minor symptoms include fever, diarrhea, night sweats and loss of weight. Others get coughs, breathing difficulties, and breathing noise. Others still can get abdominal pains, swelling liver, spleen, and abdomen gland.
We recommend that doctors first discover whether the symptoms are not because the TB is resistant and make sure the liver is not injured. Patients should hang on there because what looks like worsening will eventually go and they will recover. And for the research community, we say more work is needed to discover how we can tell IRIS from a blood test other than observing symptoms."
The research was done with Dr Mayanja Kizza Harriet, Joris Mentend and promoted by Roberts Colebunders
2. Dr Yap Boum, visiting lecturer at Mbarara University (MUST)
And director, Epicentre Mbarara Research Base
A study on the new system of diagnosis of TB
Dr Boum explained that many technologies recommended for the diagnosis of TB are not usable in many of our resource limited settings due to lack of consistent electricity, technicians to interpret them and cost of usage. But the epicenter has been testing an affordable method which is also easy to use and reliable.
"The method cultures TB organs in the sputum and reveals results in 10 days," he said. "It costs a patient about $1 (about sh3,000)."
Boum displayed results of the method he used among patients who reported to Mbarara hospital with TB in a study he conducted with Drs Patrick Orikiriza, Joel Bazira and Eleanor Turyakira.
On the conference, Boum said it was great. "But many things take place at ago and you have to choose one and miss others."
3. William Ssengooba, a laboratory manager at Makerere University College of Health Sciences
Early morning TB testing Vs one spot testing
Ssengooba presented a study comparing results from adolescents whose sputum was cultured on spot for TB to when they were asked to report early morning with fresh sputum. This biomedical scientist tested 102 adolescents from the districts of Iganga and Mayuge between Sept 2008 and Dec 2010. He discovered that it was not necessary to compel a TB patient to bring early morning sputum for culture test. "Results from culturing on spot and early morning were similar. So, Spot testing was enough," he said.
Ssengooba did the study with Namaganda Carol, Mboowa Gerald, Bugumirwa Eric and Germine Nakayita. They were supervised by Dr Wajja Anne, Professors Musoke Phillipa, ayanja Harriet, and Jobba Moses.
On the conference, he said he was happy to be in Lille. "It is great, educative and a one stop centre to meet experts, network and above all access future opportunities for upgrading, sponsors, grants education etc"
4. Dr Ester Buregyeya: Utilisation of TB/HIV services by health workers.
Doctors Buregyeya, Hassard Sempeera and Fred Nuwaha studied health workers in Mukono and Wakiso on their risk, perception and protection of TB and HIV infection. WHO recommends that all health workers be continuously tested for TB and HIV, given prophylaxis (treatment to prevent infection) and, if found infected, proper ART and TB treatment.
This study among 543 health workers between October 2010 and Feb 2011, found that there were no special TB or HIV services for the health workers in the two districts. 36% of health workers in Mukaono and 44% in Wakiso said the HIV testing at their centres were not confidential. They preferred being tested elsewhere. 26% (Mukono) and 28% (Wakiso) said they preferred to test themselves. Many have ever tested for both TB and HIV (96% Mukono, 94% Wakiso) but a few, 53% in Mukono and 47 in Wakiso, said they would disclose their status.
5. Dr Ibrahim Sendagire on edherence of TB patients in Kampala
Dr Sendagire studied whether patients of TB actually took their treatment in the right doses and the risk factors that may hinder them. He studied 270 patients at 3 different sites in Kampala from April 2007 to Dec 2009. 59% were male, 66% employed and 87% had treatment support. He discovered that 94.8% of patients actually took their doses. 54 defaulted but it was because some migrated to other areas and others died. Many of those who missed their doses frequently had no treatment supporters who called on them to make sure they adhered to their treatment.
6. Dr JB Byekwaso of Joint Clinic Reserch Council on the limitations of some methods in the diagnosis of TB
Dr Byekwaso studies 383 patients from Mildmay Centre and TASO Mulago from July 2008 to July 2009. He compared results from a microscopy observation technique (MOT) used in many sites in poor countries to those from Mycobacterial Growth Indicator Tube (MGIT) used in developed countries and discovered that 50% of patients may miss the right diagnosis because of the method used. MOT tests sputum and can miss the tuberculosis bacillus and yet it is the most affordable in poor areas.
From his study of both methods on the same samples, Byekwso revels that both MOT and MGIT agreed on same results as negative 716 times and 44 times when results were positive. But MGIT discovered TB in 6 cases where MOT had declared negative and 10 cases MOT had given as positive were negative.
However, it remains a question of affordability because MGIT costs about $31 per test and MOT $8
allAfrica.com
