Tuberculosis Infections Up 20 Percent

Prevalence rates for tuberculosis in Rwanda have shot up instead of going down, figures from the Health Ministry to coincide with World TB Day indicate.

Between 2004 and 2008, the number of those carrying the TB virus rose from 6367 to 8014, the Health Minister Dr. Ntawukuriryayo Jean-Damascene said yesterday night in his TB Day commemoration message for March 24.

The rise means there was a 20% shoot up blamed, according to the Minister, on the HIV/AIDS virus that he said destroys the body immunity systems leaving victims with very minimal protection against viruses such as TB.

According to the World Health Organisation, as testing and detection rates for TB have reduced dramatically globally, Kenya and Rwanda have seen the highest HIV testing rates in Africa for the tuberculosis (TB) care programmes.

The Global Tuberculosis Control report for 2008 released March 17 said the two East African countries share the record with Malawi as the foremost African countries progressing well in the fight against an upsurge of TB.

Between 2001 to 2005, the average rate at which new TB cases were detected was increasing by 6% per year; but between 2005 and 2006 that rate of increase was cut in half, to 3%, the WHO said.

The reason for this slowing of progress, according to the report, is that some national programmes that were making rapid strides during the previous five years have been unable to continue at the same pace in 2006.

There were 9.2 million new cases of TB in 2006, including 700 000 cases among people living with HIV, and 500 000 cases of multi-drug resistant TB (MDR-TB).

An estimated 1.5 million people died from TB in 2006. In addition, another 200 000 people with HIV died from HIV-associated TB.

The report highlights point to two aspects of the epidemic that could further slow progress on TB. The first is multidrug-resistant tuberculosis (MDR-TB), reported by WHO last month to have reached the highest levels ever recorded.

The second threat to continued progress is the lethal combination of TB and HIV, which is fuelling the TB epidemic in many parts of the world, especially Africa, the report said.

Rwanda recorded the highest rate of 76 per cent, Malawi 64 per cent while Kenya had 60 per cent to show for domestic strides in the fight against TB.

Integrated care

Rwanda, Kenya and Malawi, among other countries, have established integrated HIV/TB services, offering HIV testing and counseling, TB diagnosis, and treatment for co-infected individuals.

Dr. Michel Gasana, Director of the Rwanda's TB Control Program, says the country's "one stop service" approach centered on patients is a key feature of the program, according a news posting on the World Bank website.

Rwanda has revamped the way services are organized and financed, the Bank says.

An opt-out policy (whereby TB patients are routinely tested unless they refuse) resulted in more than 76 percent of TB patients being tested for HIV in 2006.

Under a performance-based contracting approach for HIV/TB services in the Rwanda HIV/AIDS Project, bonus payments are made to teams of providers based on results attained. This scheme has stimulated such innovative strategies as TB case-finding by community workers and home visits to co-infected patients.

Providers are encouraged to take a holistic approach to care, including promotion of institutional deliveries for pregnant women, and family planning. Systematic supervision by district officials, which is also remunerated, provides an opportunity to give feedback to staff.

Dr. Agnes Binagwaho, Executive Secretary of the Rwanda HIV/AIDS commission, notes the tremendous potential of people living with HIV/AIDS to raise awareness and promote behavior change at the community level.

She also points out that the country has given a major impetus to integration across the three major diseases (TB, HIV/AIDS and malaria).

Attacking these diseases in a joint effort is part of the World Bank's plan.

"In countries across Africa that are struggling with the co-epidemic, one cannot mention HIV without mentioning TB and vice versa," said Joel Spicer, senior health specialist in the World Bank's Africa region. Spicer emphasizes the importance of scaling up TB/HIV collaborative activities.

Working as part of the Stop TB Partnership, the African region is intensifying and scaling up efforts in TB control through its portfolio of health and HIV/AIDS projects.