Uganda’s hope of ending TB in 2030 hangs in the balance

A thirty Six-year-old Andrew Mikenga, a resident of Iganga District, is a survivor of tuberculosis (TB), a disease that killed his mother and two brothers when the family mistook it for witchcraft.

Mikenga, like other 240 Ugandans contract TB every day, said he struggled to access accurate diagnosis and the right treatment amid misinformation, partly explaining the government’s slow progress in achieving its commitment to end TB as a public health problem by 2030.

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Statistics from the government indicate that the country has already missed the mid-term target of achieving an 85 percent TB treatment success rate by 2015 after achieving only a 70 percent treatment success rate.

Specifically, the target was to reduce TB cases in the country to 155 per 100,000 or lower by 2015, based on the 2006 global commitment. However, in 2016, the Health ministry did a survey and found that it had a TB prevalence of 253 cases per 100,000 population, despite billions of shillings channeled towards the fight.

Mikenga is one of those Ugandans that TB has devastated their health, economic goals and social wellbeing.
“It was in 2010 when I was in college; they called when my mother was sick. So, I had to return home. When I returned, they had diagnosed her with tuberculosis,” he narrated.

He added: “She was started on treatment after diagnosis, but she rejected the medicines and opted for traditional medicines. She believed someone was bewitching her. Out of ignorance, I bought her idea and I stayed with her for some time because I had completed my college.”

Dr Stavia Turyahabwe, the assistant commissioner for TB and Leprosy control at the Ministry of Health, said TB is an infectious disease that spreads through the air from an infected person through coughing, laughing, singing, and talking. The disease affects the lung, but can also affect other body parts.

The common signs and symptoms of TB include coughing for three or more weeks, coughing up blood or mucus, chest pain, unintentional weight loss, night sweating, and fever.

So after some time, Mikenga also started developing similar signs of TB, but he didn’t know. He said he started coughing blood, lost weight and had chest pain.

“So the cough increased and I was advised to go for some medical check-up. I had those symptoms for about a year. So when they tested me at Iganga hospital, I was positive for TB. They started me on treatment. I underwent the treatment, but there was no change. [TB treatment takes 6 months],” he said.

The medical workers at Iganga put him on injection for another two months, but still, there was no change in his condition.

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Two years later, in 2012, they collected his sputum and took it to Uganda Virus Research Institute (UVRI), Entebbe, some 161 kilometres from Iganga Hospital, for high-level diagnosis to determine the specific type of tuberculosis causing the sickness for effective treatment.

Taking the samples to Entebbe means Iganga lacked the capacity to perform the diagnosis, but Dr Turyahabwe, told this newspaper last week that they have since introduced GeneXpert machines that can determine the specific types of tuberculosis.

“We have 299 Genexpert machines which are already deployed to test for TB. People come to test TB, but now, they can also test other diseases, including hepatitis and viral load estimation and Covid-19,” Dr Turyahabwe said.

However, the machines are not in health centre IVs and lower facilities where many people seek care.
“We are receiving more machines with higher output to add to the 299 that are already in the system. We are also introducing another technology which uses Deoxyribonucleic acid (DNA) to identify TB from the sputum,” Dr Turyahabwe added.

Mikenga said results from Entebbe revealed that he had drug-resistant TB, which left him with fear that he was going to die.

“When they brought back the results, the nurses who were working on me came from the clinic room when they were covered for the first time. I just knew I was having a very serious disease. They told me I should go back home, “we shall tell you when to come back”,” he said.

Mikenga said he was not given any medicine because they didn’t have drugs for his type of TB.
When he went back home, he became very weak and hopeless because his friends had abandoned him.
“My [skin] colour changed from dark to yellowish, probably because I had lost a lot of blood. People in the village started ignoring me and predicting that I was remaining with a few days to die. They thought I had HIV/Aids. So, I just kept on praying to God,” he said.

Mikenga said that one day as he was at home, a group of people from the United States Agency for International Development (USAID) TB project came to his home in a vehicle.

“They told me that the drug for my disease wasn’t there in the country, but they said they would buy the drug for me. I started to regain hope,” he said.

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The survivor said they started him on treatment for drug-resistant TB in 2012.
“I completed my treatment in 2014, after two years. I started on capreomycin. Then I took 14 tablets per day. They had too many side effects. I could experience stomach upsets, joint pain, somehow I lost my sight,” he said.

“But I decided to take my tablets because my target was to complete my treatment. They did some x-ray, and sputum analysis in 2014 and they confirmed that I was now okay. I didn’t buy any drugs, they were free of charge,” he said.

But not everyone is as lucky as Mikenga.  Dr Patrick Tusiime, the commissioner for National Disease Control (NDC), said up to 240 Ugandans fall sick of TB disease and 20 to 30 of them die daily. He said Covid-19 interventions and disruptions further affected the fight against TB and the goal of ending it as a public health burden.

“This has been largely caused by delays in seeking free TB services from government health facilities,” he said.

In the global target of ending TB by 2030, Uganda committed to reducing TB incidence by 80 percent, TB deaths by 90 percent, and eliminating catastrophic costs for TB-affected households by 2030.

However, the latest statistics from the ministry indicate that a total of 90,000 infections occur every year, and the disease is still killing around 25 people daily.

Dr Tusiime said they have launched a campaign dubbed Community Awareness, Screening, Testing and Treatment (CAST-TB) with the hopes to catch up with missed TB to attain global commitments. He blamed the limited progress in TB on low funding. He told this newspaper that the government has given them Shs18b this year, an amount several times below the $150m (Shs571b) that they need every year to fight TB.

US, govt efforts

Dr Jane Ruth Aceng, the Health minister, said with support from partners such as the United States government, they have increased investment in the fight. Mr Richard Nelson, the USAID Uganda Mission director, said they provide Uganda $8m (Shs30b) each year to fight TB. He said the US government will continue to support the fight against the disease.

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Dr Aceng said: “The Ministry of Health remains committed to ending TB by 2030 by providing an enabling environment for controlling and preventing the disease. Recently we have introduced a new technology for TB screening and diagnosis.”