After working closely with the clinical officer in a small community-based clinic in Changamwe, Kenya for three months, I sufficiently learned the weekly regimens for tuberculosis treatment in the Coast of Kenya. For the first two months after being diagnosed, the clients have to come into the clinic every Wednesday to collect their medicine for the week. The patients are given a yellow pamphlet that they mark each day they take their medicine to make sure they remember to take it. At every visit, the clinic staff weighs them, records their weight, adjusts the dosage depending on their change in weight and gives them any other health advice the clinical officer sees fit. If they have any questions, they always have the opportunity to meet with the clinical officer. After the first two months of weekly visits, the clients came to the clinic every other week to collect their medicines for the remaining four months of treatment. I was extremely impressed with how well this system worked by collaborating with the Port Reitz District Hospital and the small community clinic, Camp David Centre, that I worked in. The patients always seemed to feel supported and well aware of the importance of taking their medicines regularly and at the same time every day. This regimen, supported by the Kenyan Ministry of Public Health and Sanitation: Division of Leprosy, Tuberculosis and Lung Disease (DLTLD), has greatly enhanced the public health sector ability to provide free, accessible, and efficient treatment for people with Tuberculosis.
In addition to a closely monitored register of newly infected people, the free disbursement of Tb medicine coincides with mandatory HIV/AIDS testing. The DLTLD added questions regarding HIV testing and treatment to the existing TB surveillance system in 2005. The Center for Disease Control monitored the improvement in collaboration between Tuberculosis and HIV activities because HIV prevalence among TB patients is estimated to be as high as 80-90% in some areas of Sub-Saharan Africa. Between 2006 and 2009, HIV testing among TB patients increased from 60% to 88% and the prevalence of HIV infection among TB patients tested decreased from 52% to 44%. In 2009, 92% of HIV-infected TB patients received cotrimoxazole prophylaxis for the prevention of opportunistic infections. I witnessed the combination of treatment and care of the DLTLD regimen and how surveillance has really improved the health sector’s ability to respond and keep track to the new infections. However, in the most recent news there is now a lot of worry to the kind of future financial stability donors will provide to programs like this TB/HIV surveillance in Kenya.
As of January 2012, The Global Fund to Fight AIDS, Tuberculosis, and Malaria provides 82% of funds for tuberculosis around the world and has prevented an estimated 4.1 million deaths from TB. Disastrously, the donors to The Global Fund have been lacing on their commitments. Despite a devastating earthquake, and nuclear crisis, Japan acknowledges the importance of the work of The Global Fund and reconfirmed its US$800 million pledge. Bill Gates also announced a $750 million promissory note to support and encourage additional funds. Despite giving $345 million to Kenya in November 2011, The Global Fund’s Tuberculosis grants remain unconfirmed for the 2013 fiscal year. The collaborative and integrated surveillance system between HIV and TB in Kenya requires sufficient funding to continue providing free and efficient care for patients. With half of The Global Fund’s grants going to the Kenyan government and another three-eights of the grants going to Tuberculosis, the decreased funds will directly hit the people who need it most. Unfortunately, the ten-year anniversary of The Global Fund parallels the new emergency call for additional funds to continue their work. Joanne Carter, Executive Director of RESULTS/RESULTS Educational Fund (REF) and author of Huffington Post article, ends with a call to action for the United States to revamp their commitment to The Fund and consolidate increased pledges for continued financial support. Having personally observed the essential care these tuberculosis and HIV/AIDS programs provide, I echo the call to our government to provide efficient support both through the President’s Emergency Plan for AIDS Relief (PEPFAR) and through The Global Fund.