By Heather Ignatius- March 2010
TB kills nearly 5,000 people a day—that’s 1 person every 20 seconds. Of the 1.8 million TB deaths each year, over 90% occur in developing countries, further exacerbating poverty among the world’s poorest and most vulnerable populations. Fueled partially by a high burden of HIV, Tanzania is among the nations hardest hit by the TB epidemic.
For those affected with TB, successfully completing treatment is extremely challenging. TB treatment relies on 4 drugs administered over a period of 6 – 9 months, and often includes daily observation. In low-resource settings, the requirements of treatment place a tremendous burden on patients and health systems alike. The hardships of administering and completing TB treatment, including the accompanying side effects, cause many to stop taking their medicine prematurely. This leads to the development of drug-resistant TB, which is much more deadly and much more difficult and costly to treat.
The challenge of completing TB treatment is further complicated by dangerous drug interactions between TB drugs and certain anti-retrovirals commonly used to treat HIV. For the millions infected with both TB and HIV, treatment of one disease is often interrupted to administer treatment of the other.
However, recent developments in TB drug development offer hope for the future. After decades of stagnation in research and development, the first new TB drug candidates in more than 40 years have reached the clinical testing phase. One drug, which has the potential to reduce treatment to 4 months, is currently being tested at two sites in Tanzania: the Kibong’oto National TB Hospital near Moshi, and the Mbeya Medical Research Programme (MMRP) at Mbeya Referral Hospital.
As a component of this clinical trial, the Tanzanian sites have implemented community engagement programs to ensure that the communities in which they work are aware of and educated about the research.
Drawing clients from a catchment area that spans several communities across Mount Kilimanjaro’s foothills, Kibong’oto Hospital offers primarily in-patient TB care, as patients are unable to make the daily trek to receive observed treatment. The hospital staff has set up a permanent outreach department for the patients’ families and communities, as well as a Community Advisory Board (CAB)—a group of 15 local community leaders and health outreach workers who educate others about TB and the trials being conducted at the hospital and related issues.
The Kibong’oto community engagement program finds that holding public educational events on the Hospital’s grounds helps bridge the gap between the medical staff and the community. One notable event last year included an art competition open to local students. The winners’ artwork was featured in educational materials on TB disease that were disseminated in the CAB’s outreach in an effort to raise awareness and combat stigma. This year on March 24, World TB Day, the hospital will host an Open House and quiz show to educate the community about TB.
In the more urban Mbeya, community outreach by the MMRP has used call-in radio shows and theatre performances to educate the surrounding community about the issues associated with TB.
The local CAB, originally developed around participation in a previous HIV trial, consists of about a dozen community leaders such as lawyers, educators and religious leaders. This group took it upon themselves to learn about TB diagnosis, treatment, and research and expand the scope of their educational efforts. On World TB Day, the Mbeya CAB will hold its second annual march to raise awareness about the TB trials taking place in their community.
Heather Ignatius is Policy Manager at the Global Alliance for TB Drug Development, which is a not-for-profit, product development partnership accelerating the discovery and development of new tuberculosis drugs that will shorten treatment, be effective against susceptible and resistant strains, be compatible with antiretroviral therapies for those HIV-TB patients currently on such therapies, and improve treatment of latent infection.