Kenya scales up testing for tuberculosis

People living with HIV across Kenya will soon have free access to the latest technology to test for tuberculosis.

People living with HIV across Kenya will soon have free access to the latest technology to test for tuberculosis.

Nelson Otwoma, executive director of the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK), said: “TB is what’s finishing us [people living with HIV]. We are therefore requesting the government to invest in and equip our hospitals with GeneXpert machines to help in identifying TB in HIV positive persons in advance.”

The Kenyan government is purchasing GeneXpert, a testing device that detects the presence of tuberculosis (TB), for health facilities across the entire country. It is purchasing 90 per cent of the machines through a donation from the Global Fund. The remaining 10 per cent will be donated by USAID and other international bodies.

TB is the most common cause of illness and death among people living with HIV, according to the World Health Organization (WHO). And although TB can be cured, even when the infected person also has HIV, it remains the biggest challenge for people living with the virus.

Quick test results

TB testing methods were previously limited to either chest x-rays, or sputum microscopy. Patients would have to wait a long time for their results, which were not always accurate. GeneXpert is much quicker and more accurate, providing results straightaway, and also tests for drug resistance. It spares the patient the agony of having a long wait for their results and means they can begin treatment immediately.

Kenya has been trialling GeneXpert at 120 health facilities since 2012. This new initiative will see its roll-out across the whole country. Each of Kenya’s 47 counties will get a machine, while more will be provided in high HIV and TB burden counties, hard to reach areas and prisons.

Dr Cleopa Mailu, cabinet secretary in the Ministry of Health, said Kenya will officially start using GeneXpert technology to test for early TB in people with HIV in July this year.

“The government directed GeneXpert technology to be the first test for all people suspected to have TB from 1 July 2016,” said Dr Mailu. “The ministry drafted a policy to government on GeneXpert testing, recommending its use among individuals suspected to have drug-resistant TB or HIV-related TB.”

Renewed efforts to fight TB and HIV

For many years, efforts to tackle TB and HIV were largely separate despite the overlapping epidemiology. This led Kenya’s ministry of health to launch a campaign dubbed “Mulika TB, Maliza TB!” – Swahili words meaning “Find TB, Treat TB.”

Through these interventions, in 2015, the ministry launched Isoniazid Preventive Therapy (IPT). This aims to protect people living with HIV from developing active TB and also to prevent children under the age of five, living with TB-affected persons, from getting TB.

According to the cabinet secretary, last year 100,000 people living with HIV started IPT, with another 800,000 Kenyans to be enrolled this year. This number will make Kenya the country with the highest number of people receiving this treatment globally.

Dr Mailu said it is distressing to note that TB is still the fourth leading cause of death in Kenya. He added: “I am confident that through the ongoing implementation of preventive therapy, using Isoniazid to protect people with HIV from developing TB, we can further reduce the number, including children under five in contact with persons with TB.”

Free testing

Dr Nicholsa Muraguri, principal secretary for health, said that Kenya has achieved universal access for HIV testing among TB patients and universal access for antiretroviral treatment for those with HIV and TB. This follows the WHO recommendation on implementation of collaborative TB and HIV activities. As a result, the TB/HIV co-infection rate in Kenya has reduced from 70 per cent in 2010 to about 30 per cent in 2015.

Dr Muraguri said the government has taken initiative to ensure free and universal access to TB testing and treatment, with services accessible across 4,500 health facilities and 1,800 testing sites.

He said: “In 2015 alone, nearly 80,000 TB tests were performed, up from 20,000 in 2014.”

Dr Mailu added that in the last 10 years, over four million Kenyans have been tested for TB and 1.2 million people found to have the disease have been successfully treated. These efforts saved the lives of over 500,000 Kenyans.

Fight not over

However, the fight against TB is not yet over as the disease remains one of the nation’s largest public health threats. Dr Mailu said that although the public is aware of TB, and the government offers free testing services, many people wait too long before they see a doctor, while others don’t go at all. The minister added that more than half of TB cases in Kenya go undetected.

Otwoma said although he was happy that GeneXpert would be more widely available, the government still isn’t doing enough to ensure that HIV/TB co-infection is completely wiped out.

“Most of the community health workers and nurses operating the GeneXpert machines have not been provided with the right education on this important equipment,” he said. “Even awareness hasn’t been provided to the public on the availability of this life-saving machine.”

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