According to World Health Organization’s Global Drug-resistant TB Initiative, ‘Drug-resistant tuberculosis (DR-TB), particularly multi-drug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB), represent significant threats to global TB control efforts and a major public health concern in several countries. The World Health Organization (WHO) estimates that worldwide 450,000 people developed multi-drug resistant TB (MDR-TB) and at least 170,000 deaths were caused by MDR-TB in 2012’. In Uganda, a survey conducted in 2010, estimated MDR-TB prevalence at 12.1% among previously treated patients and a 1.3% among new patients and until July 2013, there was limited access to treatment with only three treatment facilities in the entire country.
Since May 2013, the Uganda Ministry of Health has been collaboratively working with the USAID Strengthening Uganda’s Systems for Treating AIDS Nationally (USAID/SUSTAIN) project to manage the illness at four regional referral hospitals: Mbale, Masaka, Gulu and Fort Portal. One MDR-TB patient at Mbale Regional Referral Hospital (RRH) now shares his story.
Straining to speak with a seemingly clogged throat, Godfrey (27) says his struggle with TB started in 2007. He wasn’t feeling well, was coughing and his breathing was labored, but he didn’t think much about it until his three-month-old son started coughing as well. Early in 2008, Godfrey took his son to Mbale RRH, where tests revealed that they were both sick with TB. They were initiated on TB treatment and eight months later discharged.
Godfrey immediately resumed work at his carpentry shop, but taking on a supervisory role to minimize his exposure to a dusty environment that would strain his chest. He was also diligent about taking the necessary maintenance medicines.
‘Continuing my treatment was not difficult, because the medicine was available’, Godfrey recalls, wheezing hard.
In 2010, Godfrey started to feel what he described as ‘a heavy pain in the chest’, but he never got any wet cough. ‘The pain was sporadic, so I took ordinary pain-killers’, Godfrey said.
Over the next two years, Godfrey’s cough worsened and he lost weight, but he was reluctant to return to the hospital for more testing because he didn’t want to put additional strain on his family’s resources. Finally bowing to pressure from his family, Godfrey returned to Mbale RRH, where he tested positive for TB once again.
‘I was not surprised at the diagnosis, because all the symptoms were the same as those I experienced in 2007. I also knew the medicine was readily available. My worry was how to support my family if I was admitted to the hospital for two months again’, Godfrey said, trying to explain why he waited so long to return to treatment.
According to the TB Clinical Manager at Mbale RRH, Damalie Namuyodi, Godfrey physically responded to the re-treatment progressively, but his sputum sample tests five months later revealed he was not healing.
Godfrey was then given a different kind of medicine with the hope the he would heal by the time the treatment course was completed. A sample test of his sputum taken two months after he started the new medicine regime showed that he was responding well. Godfrey resumed his job, albeit with reduced hours at work. However, during his last month of treatment, he got an intense and persistent cough.
‘I was often drowsy and tired. I would come home from a long day of work, but instead of being able to relax, my cough would continue to disturb me and I would have to take more medication’, Godfrey said.
He returned to Mbale RRH where his sputum sample was taken and a culture and drug sensitivity test was done. Eight weeks later, it was confirmed Godfrey’s TB was resistant to all the medicines he was taking. He was diagnosed with MDR-TB, which is caused by TB bacteria that are resistant to Isoniazid and Rifampin, two of the most effective anti-TB drugs.
Godfrey was sent home and a group of doctors from Mbale, together with a team from USAID/SUSTAIN and the Uganda Ministry of Health, soon visited him at his home to assess the feasibility of a home-based treatment model. He was counselled about the duration of treatment and various measures to prevent him from passing on the infection to others. He was provided with protective gear for use by his family members to avoid spread of the infection.
According to Damalie, Godfrey is one among five MDR-TB patients receiving care at Mbale RRH who have shown great improvement in the eight months since starting the treatment. ‘Godfrey has committed to his treatment and has not missed taking his drugs in the six months we have been treating him. Our hopes are high he will overcome this infection’, Damalie said
Since April 2013, the USAID/SUSTAIN project has been working with the Uganda National TB and Leprosy Control Programme to support care and treatment of 60 MDR-TB patients, and case investigation is on-going. In 2014, the USAID/SUSTAIN project will support establishment of three more treatment centres at Kabale, Mubende and Arua, and remodel the DR-TB care physical infrastructure of all the seven centres to enable effective implementation of TB infection control measures and enhance health care provider safety at the workplace.
 “Global Drug-resistant TB Initiative,” Stop TB Partnership. http://www.stoptb.org/wg/mdrtb/. Accessed 20 March 2014.