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TB-Free through Drug Adherence

Mutuati, Kenya—When Esther Mwendwa started coughing in July 2015, she thought it would resolve without much effort on her part. The 29-year-old teacher at Mutuati Secondary School bought over-the-counter drugs to treat the cough.

However, two weeks later, her cough persisted, and she was sweating a lot at night. Esther decided to visit Mutuati Subcounty Hospital—the same facility she had attended for postnatal services when her son Modecai was born.

“I thought I was suffering from malaria and pneumonia, but after two weeks of taking drugs with no improvement, I visited the hospital for treatment,” Esther explained.

TB Testing and Treatment

At the hospital’s Maternal and Child Health Clinic—where Esther had sought reproductive health services in the past—she was screened for TB and referred to the laboratory, which confirmed that she had TB.

“When I tested positive for TB, I was scared. I had very little information about the disease. But, during counseling, I was reassured that with proper care and drug adherence, I could successfully fight the disease,” Esther said.

August 2015, the school holidays, marked the beginning of Esther’s treatment. She visited the Mutuati Subcounty Hospital regularly, without fail, to pick up her drugs.

“After two weeks of taking TB drugs, I started feeling better,” she said. “Nonetheless, from the health education I had received during my visits to the facility, I knew I had to take the drugs consistently for the prescribed six months.”

A Setback

But three months into her treatment, Esther had concerns about the health of her son, Modecai. He was losing weight. Esther worried he too might have TB. When she shared her concern with her nurse at Mutuati Subcounty Hospital’s Chest Clinic, the nurse advised her to bring him in for further testing.

“My son, who was breastfeeding at the time, was coughing, and after thorough tests, he tested positive for TB,” Esther said.

Because people with TB infection are more likely to die from this disease if they are also living with HIV, both Esther and her son received HIV testing and counseling during their TB screening. Both were negative for HIV.

TB-Free

Esther and her son learned how to stay safe and healthy throughout their treatment. In January 2016—six months after she had begun her treatment—Esther was declared TB-free. Three months later, her son Modecai was also TB-free.

“The main lesson I’ve learned from this is that most people, just like I did, do self-diagnosis due to lack of information,” Esther said. “TB treatment is free, and it’s important to visit a health facility for a test and treatment. I am now confident enough to discuss TB with my peers and students to ensure they have access to TB information.”

According to Silas Muturia, nurse-in-charge at the Chest Clinic, getting patients to stick with their treatment can be a challenge.

“Many patients stop the treatment once they start feeling better, which ends up interfering with anti-TB therapy,” Silas said. “Stigma is another major challenge, but we try to change that by continuously educating our clients.”

Esther, however, complied with her drug regimen. “Esther and her son adhered to drugs and followed the nutrition health education I gave her. She also observed cough etiquette to avoid further transmission of TB,” Silas said.

Mutuati Subcounty Hospital is currently treating more than 120 TB patients, one of the highest TB caseloads recorded in Meru County.

“One of the reasons for this high number is lifestyle, overcrowding. Our young people—hired to harvest miraa—live in large numbers in tiny rooms,” Silas explained. Miraa is a cash crop and one of the main income-generating activities in the region.

Silas encourages people in the community to visit the health facility quickly, once symptoms emerge, to receive free TB services.

 In partnership with the government of Kenya, APHIAplus KAMILI, a project led by Jhpiego, supports the Chest Clinic at Mutuati Subcounty Hospital by providing mentorship and continuous medical education to health care providers on how to identify and treat people with TB. Included in these efforts is support to health care providers who work with GeneXpert, a test that improves TB detection,  delivers results in less than two hours and identifies drug-resistant TB.

“The project supports GeneXpert task force meetings and sample transport to GeneXpert sites. We also conduct joint site supportive supervision with county health management teams,” explained Josephat Bett, APHIAplus KAMILI’s HIV and TB Program Officer.

The project also sensitizes health workers on providing TB therapy for people living with HIV without symptoms of TB. From January 2015 to June 2016, the project helped identify 6,309 individuals with TB and placed all of them on treatment.

Together, the efforts of Jhpiego and Mutuati Subcounty Hospital are aimed to ensure that women and children like Esther and Modecai receive the quality care they need to reach a TB-free life.


 Samuel Mwaura is a Senior Program Officer, and Serah Njenga is a Communication Officer in Jhpiego’s Kenya office.