Lesotho struggles to contain spread of tuberculosis

Lesotho is "struggling to contain" the spread of tuberculosis in the face of its HIV/AIDS epidemic, IRIN News reports. In 2006, the country reported 12,000 new TB cases, but TB expert Peter Saranchuk of Medecins Sans Frontieres said the actual number of cases likely is much higher.

In addition, Saranchuk estimates that there are "vast" numbers of undiagnosed TB cases because roughly 85% to 92% of HIV-positive people in the country also have TB. The capacity to perform culture testing to diagnose TB among HIV-positive people is limited in Lesotho, and sputum samples must be sent to South Africa. Results typically are not returned for six weeks. Although TB also can be diagnosed among HIV-positive people using X-rays and clinical assessments, the strategy is relatively new, and Lesotho's department of health and social development still is training health workers in how to manage the two diseases, according to IRIN News. Coordination between Lesotho's TB and HIV/AIDS programs has not been common until recently, IRIN News reports. TB and HIV treatments previously were available at different sites, and few health professionals working on the two diseases collaborated. To address the issue, the department of health and social development established a strategy to control the two diseases that includes training health workers and counselors in both diseases; routinely offering HIV testing to people with TB; screening HIV-positive people for TB; and providing treatment for both diseases at the same site. Michael Sekokomala -- head of Lesotho's largest TB outpatient clinic at Botsabelo Hospital in the capital, Maseru -- said more work needs to be done to implement the strategy. There is a shortage of counselors at the clinic to provide HIV testing to all patients, and people who have both diseases are required to make separate appointments to receive antiretroviral drugs at a nearby HIV/AIDS clinic. In addition, different strategies are used to ensure that patients adhere to their TB and HIV/AIDS treatment regimens. The DOTS strategy is used for people with TB, while HIV-positive people receive adherence counseling to ensure that they understand the importance of following their daily treatment regimens on their own. Shoeshoe Matsoele, deputy manager of Lesotho's TB control program, said that the DOTS strategy can be adapted to cover adherence to antiretroviral drugs. Matsoele added that volunteers trained in DOTS also can be trained to monitor adherence to antiretrovirals.

Drug-Resistant TB
The spread of multi-drug resistant TB and extensively drug-resistant TB, which is resistant to the two most potent first-line treatments and some of the available second-line drugs, also is causing concern in Lesotho, IRIN News reports. The country has a very limited capacity to determine the extent of MDR-TB and address the disease because culture testing is the only sure way to diagnose MDR-TB. "We don't know how many MDR cases we have," Sekokomala said, adding, "We just have MDR suspects, so XDR worries us very much, because if we can't even manage MDR, how can we manage XDR?" Sekokomala said that he believes there likely are XDR-TB cases in Lesotho because of the number of his patients who have died while undergoing treatment. There also is a lack of infection control measures in Lesotho's TB wards and clinics, according to IRIN News. Sekokomala said people thought to have MDR-TB are admitted to the TB ward at Queen Elizabeth II Hospital, the largest in the country. "There's only a corridor separating the TB ward from the children's ward, and children play in that corridor," he said. The Lesotho government is in the process of finalizing emergency guidelines for addressing MDR-TB and XDR-TB, and it recently entered into an agreement with Partners in Health to open a 40-bed isolation ward for MDR-TB cases at Botsabelo Hospital that is expected to open in May. Jennifer Furin, director of PIH in Lesotho, said she has been impressed with the government's swift response to the spread of drug-resistant TB but added that she is most concerned with the potentially high number of undetected MDR-TB cases (IRIN News, 3/28).