In 2014, tuberculosis overtook AIDS as the leading infectious disease killer worldwide with 9.6 million people becoming ill and 1.5 million dying of TB. TB remains the leading killer among people living with HIV. Ending the TB epidemic by 2030 is one of the health targets of the newly adopted United Nations Sustainable Development Goals.
Jhpiego has been working in nine countries across numerous programs to ensure that our broader health initiatives integrate TB into their projects to ensure that people receive prompt diagnosis and access to treatment.
Moses Kitheka joined Jhpiego in 2011 as a technical advisor for the APHIAplus Kamili program and is now the Chief of Party. Moses has a strong professional background fighting against TB and is a keen advocate for ensuring his colleagues at Jhpiego and the organization “think TB.” He recently hosted a webinar about TB and Jhpiego’s leading activities to prevent and treat this curable disease and the importance of identifying where we go from here to end TB.
Alice Christensen, HIV and TB Regional Advisor, Jhpiego Tanzania, met with Moses recently and discussed current TB programming in Kenya and worldwide.
Q: Tell me how you became interested in TB.
A: Before joining Jhpiego, I worked with the Kenyan Ministry of Health on the National TB Program and for three years in the TB regional control zones. This gave me an entry into my public health career. At Jhpiego, we have TB/HIV collaborative activities under the APHIA programs. This has become my passion because I thought, in my effort to better the health of Kenyans suffering from this “neglected” disease, “Why not give it my all?”
Q: During our participation at conferences sponsored by the International Union Against Tuberculosis and Lung Disease, I saw your advocacy skills at work and appreciate your continued emphasis on raising awareness about TB within Jhpiego. I also know that TB is often a forgotten disease. Can you tell us what the current TB situation is in Kenya?
A: Kenya is one of the countries that has made great strides in TB control. However, Kenya is also one of the 22 high-burden countries, which means it contributes a lot to the global burden of tuberculosis. With that realization, the Ministry of Health has put a great deal of resources into TB control. The U.S. Government and other donors and implementing partners have supported the Kenyan government in this endeavor as well. Although there was a general increase in TB cases starting in the 1990s, we started seeing a decline in TB beginning in 2007. Kenya is currently reporting around 90,000 cases of TB each year.
The TB program has decentralized diagnosis and treatment of TB services to most health facilities. That’s important because about one-third of people who have the disease are never diagnosed. Decentralizing services helps get care closer to the people who really need it. Kenya has done quite well and reached its case detection and treatment success targets on time. Last year, Kenya had 250 cases of multidrug-resistant TB; most of those people received treatment. The programmatic management of drug-resistant TB in Kenya began around 2007, and ever since there has been a focal person who has helped with that.
In terms of TB/HIV control, Kenya was one of the first countries to integrate services for TB and HIV. Our team was one of the first adopters to really work on that very closely with a project at Karatina District Hospital. We started the integration of antiretroviral therapy at TB clinics and that has really rolled out across the country.
Currently, over 95% of patients who have TB also receive an HIV test, and over 90% of all TB/HIV co-infected patients are started on antiretroviral therapy.
Q: It sounds like you have made great strides in Kenya. But what more can be done to end TB?
A: In spite of the decline, TB still remains a relatively neglected disease. Many people are not aware of TB. So a lot of advocacy needs to be done across the board. We need to identify the groups of people who are hard to reach, detect TB and offer them treatment—I’m talking about women, children and people in informal settlements. We have done good work in prisons.
But the other key overarching problem is a decline in funding, which has been a major challenge. The government of Kenya, much as it has tried to increase resources, still has a huge funding deficit. The other big challenge is a global challenge—finding better TB medicines that are more accessible and more patient-friendly. The current long regimen means adherence to treatment may be a challenge.
Q: For those who don’t know much about TB, what is the standard regimen and what are some of the issues around the medicines that we are currently using for TB?
A: The good thing now is that TB treatment comes in a treatment pack for patients—the entire six-month regimen [a two-month intensive phase and a four-month continuation phase] is in one treatment pack. That has simplified treatment, especially for health care providers who don’t have to prescribe the individual medications that are needed to treat tuberculosis. Having the entire treatment in one pack also helps to ensure that people adhere to their treatment—the drugs you need are all in one place.
The challenge is the treatment occurs over a long period of time, especially for those who have drug-resistant TB and need to be on treatment even longer. Any time you have to take a drug for six months, adherence becomes a big challenge. Then there is the issue of stigma, which affects adherence. For a long time, people have associated TB and HIV. So if you have TB, people automatically made a connection that you have HIV and AIDS, therefore, people are not willing to seek treatment. This especially affects men, who generally have poor health-seeking behavior. When they have TB, they generally don’t come for treatment early.
Q: What can we do in the global health arena to highlight the issue of TB and hopefully come together to work towards ending TB?
A: I think action number one is to talk more about tuberculosis, which I think we are doing in our community and that’s quite good now. But number two is to see what more we can do in terms of integrating TB into the service delivery platforms we have. For instance, how can we better use the maternal and child health platform to address tuberculosis? Raising awareness about TB in children is another avenue to pursue aggressively.
Then there is a platform of non-communicable diseases, we know there is a close association between diabetes and tuberculosis. That is probably a platform we could use—the non-communicable disease platform—to see how we can better address TB control efforts.
And most important, for Jhpiego, is to speak about the work we have done and are doing, so people know that we are playing a critical role in TB control and are looking for strategic partnerships to advance our TB control agenda.