A win for TB-HIV co-infected patients in Kenya

Khairunisa Suleiman and Evaline Kibuchi
Nov. 24, 2017, 2:57 a.m.
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Kenya to roll out the TB LAM test in response to effectively addressing the high TB-HIV co-infection burden in the country.

21 November 2017: At the recent TB Ministerial Conference in Moscow last week, Principal Secretary (PS) of the Ministry of Health Julius Korir announced that Kenya will be rolling out the TB LAM test. This is in response to effectively addressing the high TB-HIV co-infection burden in Kenya. In 2016, an estimated 53 000 cases were co-infected by TB and HIV in Kenya, devastatingly almost half of those people died (24 000 cases), which could partly be attributed to late diagnosis and late treatment initiation.

LAM is a protein that is shed off by TB bacteria, when the TB bacteria spread to the kidneys. The LAM protein is passed into urine and detected by the TB LAM test. Most TB tests are sputum based tests, TB LAM responds to the existing challenge of diagnosing TB in people living with HIV (PLHIV) with low CD4 counts who have difficulty in producing sputum. TB LAM is recommended by the World Health Organization (WHO) for use in people and children living with HIV with advanced HIV or severely sick and with low CD4 counts of less than or equal to 100 cells/mm3 . According to the recent WHO report, in 2016 alone, 400 000 people living with HIV died from TB. TB LAM is one of the few TB tests shown to save lives, since TB LAM is a rapid test that allows patients who are at a high risk of death to be initiated on TB treatment on the same day. TB LAM shouldn’t be restricted for use in hospitals only, since evidence shows its use in ambulatory care too. The test is to be followed up by GeneXpert for greater sensitivity in diagnosing patients.

TB LAM has had low uptake globally since it was recommended for use by the WHO in 2015. Only a few countries have rolled out the test, which almost led to ceasing test production by Alere this year. Uganda and South Africa are leading in the implementation of TB LAM in Africa.  In Kenya, TB advocates pushed for TB LAM use through a letter to the National TB and Leprosy Department–Program (NTLD-P) in Kenya. This facilitated the welcomed decision by program head Dr. Kamene Kimenye and other stakeholders to fast track integration of TB LAM into the TB diagnostic algorithm. The NTLD-P should be commended for taking the unprecedented steps of inviting civil society to provide their input into policy development of TB diagnostic tools, which enables a more patient based approach to diagnosis. Kenya joins the first few countries globally to roll out TB LAM.

The Ministry of Health has allocated USD 300 000 for the procurement of TB LAM tests, hence about 85 710 tests will be purchased at a cost of USD 3.50 per test according to the manufacturer’s price. As civil society, we will be monitoring the roll out of the TB LAM to ensure that it is fully financed and facilitated in terms of capacity building for the health workers to implement the new technology. The TB LAM test will be launched on World TB Day (24th March 2018) in Kenya.

In a meeting with development partners, the NTLD-P and civil society prior to the Ministerial Conference, PS Korir showed his political will to addressing TB-HIV co-infection by suggesting a meeting between the national HIV (NASCOP) and TB (NTLD-P) programs before the end of the year. These progressive strides to enhance collaboration are needed, as often, the two programs are perceived to have limited collaboration in certain areas and may limit rapid implementation of new drugs and diagnostic tests for the TB-HIV co-infection population. Greater collaboration between national HIV and TB programs can also be achieved by having collaborative indicators such as attendance in policy development working groups of new drugs and diagnostic tests to be used in the TB-HIV co-infected populations. Another collaborative indicator is the amount of financial contribution and effort by the two programs to diagnose and treat the TB-HIV co-infected persons.

Hopefully the meeting to be convened by PS Korir will discuss an analysis of current collaboration and how to achieve greater synergy between the national HIV and TB departments.

By Khairunisa Suleiman and Evaline Kibuchi

Khairunisa Suleiman is a member of the Global TB Community Advisory Board (TB CAB) and a Public Health Consultant. Evaline Kibuchi is the Chief National Coordinator of Stop TB Kenya.

We thank Dr. Kimenye for availing financial data regarding the roll out of TB LAM in Kenya.