Investing in the Global Fund is the smart thing and the right thing to do. In reality, $5 billion to save lives and support developing countries is less than one-half of one percent of what G8 countries have approved to bail out failing banks in the last three months.
— Jeffrey Sachs, Director of the Earth Institute and Special Adviser to the U.N. Secretary General
In this time of economic crisis, I say to you that spending on AIDS, TB and malaria is a smart investment. The Global Fund is helping countries to set ambitious targets. It is helping them to achieve concrete results. And it is giving affected populations a real voice in programs and policies that affect them.
— Ban Ki-moon, United Nations Secretary-General, March 2009
Tuberculosis Patients Discover the Miracle of Medicine
When Amare Truneh got sick, he left home. He'd been working as a teacher, but was worried he might have AIDS and was so afraid his reputation could be ruined that he left town and travelled more than 100 kilometers to Addis Ababa. He fixed his hopes on a renowned holy shrine where he went to pray for a full recovery.
It's a long steep climb up to the community of Entoto in the eucalyptus-filled hills just outside the capital city. Many of the pilgrims who have gone to seek solace at the shrine have tuberculosis - the most common disease in the country. The faithful visit the natural spring to pray for good health, drinking and bathing in the holy waters presided over by Ethiopian Orthodox monks.
Amare's condition did not improve on arrival at the shrine; camping outdoors on the chilly mountainside and struggling to survive on alms contributed to a decline in his health. His cough got worse and the monks advised him to seek medical attention in addition to his spiritual devotion.
St Peter's TB Clinic, Addis Ababa
St Peter's TB clinic is located opposite the entrance to the shrine. The clinic monitors the health of the shrine's congregation, encouraging people with a nasty cough to undergo medical examination. TB tests are financed by the Global Fund, as is treatment if TB is confirmed.
The Patriarch of the Orthodox Church encourages the faithful to use modern medicine. He has publicly decreed that faith and holy water are not the only cures for disease - "Drugs are also works of God".
Amare was diagnosed with TB, hospitalized at St Peter's during the contagious phase of his illness and put on a course of treatment. He could return to his home town to continue his course of drugs because TB treatment, financed by the Global Fund, is available at all health clinics across the country. But TB is not the only health problem he has - Amare was counseled to get tested for HIV.
Co-infection of HIV and TB is high in urban areas
Amare agreed to be tested, as most patients do. Many HIV test sites will only advise testing in response to a direct request, but given the high correlation between TB and HIV it is recommended the test be offered as a matter of policy to TB patients in areas of high HIV prevalence - a practice known as provider-initiated HIV testing and counseling.
Amare was diagnosed as he suspected - HIV-positive. The virus had weakened his ability to fight TB. In urban areas of Ethiopia, around half of TB patients also have HIV. The Global Fund pays for testing and for antiretroviral drugs (ARVs) if the patient is found to be HIV-positive, as well as vitamin supplements to counter the toxic effects of high doses of medicine. TB treatment comes first, until the patient is no longer contagious.
Amare is no longer considered a critical TB case and is taking ARVs. Amare says that when he is better he wants to go back to being a teacher - but with a difference: he wants to teach preventing and curing disease thanks to the modern miracle of medicine.
Nargis Akter, a 28 year old former TB patient works as a ‘Shasthya Shebika’, or community health volunteer, in Bandutia; a village in the Manikgonj district of Bangladesh. Four years ago she developed a serious cough and fever and because she could not eat at all, began losing a lot of weight. Because she was already taking part in a micro-credit program with Bangladeshi NGO BRAC, one day a BRAC health worker recognized her symptoms. Nargis was tested, found to be TB positive and after a six-month-course of medicine supervised by a Shasthya Shebika volunteer, was cured. Nargis now works as a Shasthya Shebika herself and monitors other patients taking their TB medicine. She knows firsthand that awareness, early diagnosis and regular treatment are the most important tools in fighting TB.
Winstone Zulu is a dear friend and partner of RESULTS. He was born in Zambia as the sixth of thirteen children. He was diagnosed with polio at the age of three, has been living with HIV/AIDS since 1990, and became sick with — and was cured of — TB in 1997. TB has affected Winstone's life in profound ways. We’d like to read a short description he wrote about the impact that TB and HIV/AIDS have had on his life. His story has moved us out of our ignorance and complacency, and like him, we are now dedicated to fighting this deadly co-epidemic.
“My brothers Erasmus and Christopher got tuberculosis at around the same time. It was so tragic. Erasmus died on the 7th of December 1990 and his wife died the following day, and then Christopher died a week later. And then there was Shadrek, he was the eldest of all of us. He worked for BP, he was a truck driver. He left six children. He died in 1996 from tuberculosis as well. His wife died the following year. Danny, he was the youngest. Danny was a really good musician, he used to work in South Africa. Then he came back and we started living close to each other, we became very close. He died in 2003.
“They shouldn’t have died. TB is preventable, whether people are HIV-positive or not. TB treatment gives patients more time. If my brothers had survived TB they might have lived long enough to access HIV drugs like me.
“We adopted my son Michael before the era of prevention of HIV from mum to child. He is 9 years now and has had TB but got cured. He is on antiretrovirals for HIV infection. I also directly support Matildah and Clara who are my late brother Shadreck’s daughters, Musa and Morey who are late Christopher’s kids. There are other nieces and nephews that I help too but they are looked after full time by my sisters.”
Winstone’s story highlights that we cannot separate the epidemics of TB and HIV/AIDS and that unless we act more urgently and with the resources commensurate with the problem, TB will continue to be a needless tragedy that aggressively kills those with HIV/AIDS. While there is no cure for AIDS, there is a cure for tuberculosis. This World AIDS Day, we cannot forget that the fight against AIDS cannot be won without the fight against TB. We hope we can work with you to increase the U.S.’s support for bilateral TB programs and the Global Fund to Fight HIV/AIDs, TB and Malarai, which is having a huge impact in Zambia and many other countries.
This excerpt, from a Partners in Health doctor, expresses the challenges, but also the transformational power, of detecting and treating TB and HIV/AIDS in poor countries. He traveled to a village in the mountains of Lesotho, which took six hours by horse, to visit a very ill patient named Mathabo.
“When I entered her house, Mathabo was too ill to sit up on her bed to greet me, though I knew she wanted to. She was coughing a lot and was extremely thin. Her skin-tone was not a healthy colour, most likely from anemia. Because she wasn’t able to move, I couldn’t weigh her, but I estimated her weight to be only around 35 kg (less than 80 pounds).
“At that time, Mathabo was 35 years old. She had lost her partner over seven years ago, most likely to AIDS. She had pulmonary TB three years ago and had been treated for pneumonia several times. Her symptoms included severe weight loss, coughing, night sweats, diarrhea, thrush, loss of appetite and loss of skin tone. Mathabo gave her consent and I tested her for HIV. Her test showed positive. I also diagnosed her to have . . . TB, so I started her immediately on TB medication and fluconazole. I drew her blood to send for a CD4 count and gave her some money for food.
“Unfortunately, we never received the results of Mathobo’s CD4 test. As I soon learned, many samples never make it to the lab. They simply disappear somewhere along the line of drawing samples, coordinating them, shipping them down with the pilots (since the clinic is accessible only by small planes), and then couriering them to the central lab in Maseru. Even when samples do get to the lab, the results often fail to make the reverse trip back to us in the mountains.
“Two weeks after seeing Mathabo, I was visited by her VHW (Volunteer Health Worker) at the clinic. She reported to me that Mathabo was doing much better already. . . . When she first stepped into the room, I didn’t recognize her. I had to rely on the VHW to vouch that this was Mathabo. Her complexion was much improved and she had gained some weight. Although we still didn’t have a CD4 result for her, I decided that she was ready to begin antiretroviral therapy. She no longer had any of the symptoms she had over a month ago and she weighed 46 kg (102 lbs). I took another blood sample to send to Maseru for a CD4 count and enrolled her into our food program, where each patient gets enough food every month to feed him or herself plus four family members.” 1
Mathabo almost died of TB, despite drugs costing as little as $20 that are effective in 95 percent of cases. The challenge of testing for and fully treating TB, described in this account, is leading to the spread of drug-resistant TB, which is entirely man-made and arises from incomplete or ineffective treatment of standard TB. Anti-retrovirals do not provide protection from TB, and the spread of drug-resistant TB threatens to rollback progress fighting HIV/AIDS in Africa. This is why we advocate for increased bilateral funding to fight TB, and an increased U.S. commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which, since 2001, has detected 5 million cases of infectious TB, cured 3 million people, and treated 24,000 cases of drug-resistant TB.
1 Jonas Rigodon, "A doctor's journal: Home visit in the mountains of Lesotho," http://www.pih.org/inforesources/news/Jonas_docs_story.html
