On World TB Day 2022, this blog seeks to amplify some stories and experiences from TB patients, healthcare workers and advocates across Kenya, to raise awareness of one of the deadliest infectious diseases and advocacy efforts to #EndTB. We touch upon some of the meetings, briefings, photographs and videos provided to parliamentarians in a recent 'virtual trip' to Kenya.
Before the COVID-19 pandemic, RESULTS UK regularly took delegations of parliamentarians to other countries to see first-hand the work that our partners and UK Government-funded programmes do to support people living in poverty and people affected by the issues we advocate on, such as TB. These delegations can be a powerful way to build relationships with parliamentarians and encourage them to become champions on issues we care about. However, COVID-19 forced us to take a different approach. Unable to safely travel, we tried to replicate as much of the experience of an in-person trip as possible from behind a computer screen, and in 2021 hosted a ‘virtual delegation’ to Kenya.
Working alongside our partners Results Canada, our sister organisation in Canada, and KANCO, a membership organisation in Kenya working to eradicate HIV and TB, we devised a way for UK parliamentarians to meet with TB patients and advocates, healthcare workers and Kenyan MPs to discuss what more needs to be done to bring the TB epidemic to an end.
We would like to thank Rahab Mwaniki, Allan Ragi, Elvis Saitoti, Professor Joseph Nhung’n, Msoni Timothy, Hilary Ndalu, Eric Mose and Dr. Ezekiel Karino for sharing their experiences, which highlight why advocating for an end to TB is so important.
Welcome to Kenya
TB is a serious public health issue in Kenya. About 140,000 Kenyans a year develop TB (approximately 35,000 people are co-infected with HIV/AIDS) and 21,000 people die from it. It is the fourth largest cause of death in Kenya, responsible for around 6% of all deaths. Kenya also suffers from growing levels of antimicrobial-resistant TB (AMR-TB) and multi-drug resistant TB (MDR-TB) which means the bacterium has learnt to overcome some medication, making it incredibly difficult and costly to treat. Combatting TB in Kenya requires a holistic approach, incorporating local communities, medical professionals, politicians, international health NGOs and governments all working together.
KANCO’s expertise in mobilising politicians and local community activists around health issues was invaluable to the success of our delegation. We hope one day that some parliamentarians will be able to take up KANCO’s warm welcome to visit Kenya in person.
Living with TB in Kenya
Msoni Timothy is a pastoralist from Shompole, Kajiado. Msoni contracted multi-drug resistant TB while pregnant and didn’t seek treatment until the second trimester of her pregnancy, when her condition deteriorated. Msoni talked to us about how difficult it was trying to deal with pregnancy alongside her treatment for MDR-TB.
Msoni attended the local health centre in Shompole as her condition deteriorated. While at the health centre, her blood and sputum was tested for TB and, once it was confirmed, Msoni was prescribed medication to help fight the disease. For the next 18 months, she had to take an extensive regimen of medication, often without eating food, which had many side-effects. The Shompole Health facility has benefitted from funding from the Global Fund to Fight AIDS, TB and Malaria, which provides 77% of all international finance for TB.
Msoni was given the all-clear for TB and praised the Shompole health facility, which was able to provide her with the diagnosis and medication she needed.
Hilary Ndalu was born and raised in Kangemi, an informal settlement in Nairobi. He had a successful job working in a restaurant at a golf club before he was diagnosed with TB. After this diagnosis, he had to give up his job, which made it hard for him to put food on the table for him and his family.
Hilary initially visited Kangemi Health Centre, a public institution supporting TB in Kenya supported by the Global Fund, because he thought he might have COVID-19. But after the health centre ran some sputum tests, Hilary was diagnosed with TB. Hilary talked about how there had been disruptions and difficulty accessing doctors as a result of the COVID-19 pandemic, but that doctors and nurses called and visited him outside of the health centre to check on his progress and support him in taking the medication as prescribed. He said that this made patients feel good and ensured that the “doctor-patient relationship does not end at the hospital”. Hilary’s course of treatment was free of charge, from the initial diagnostic to the final blister pack of medication. He urged advocates and governments to keep fighting to secure funds to ensure that health facilities could continue to provide medication to TB patients free of charge.
TB healthcare during the COVID pandemic
Lab workers, nurses and doctors in health centres across Kenya face numerous challenges in trying to improve TB outcomes, including lack of logistics for diagnostic tools, the stigma attached to TB treatments, and insufficient community understanding of the disease itself. These problems have been exacerbated by the COVID-19 pandemic. At Shompole Health Centre, Elvis Saitoti, Clinical Officer, explained how healthcare workers found themselves working outside of normal hours to try and ensure all patients were being treated, and having to carry out different roles.
While this is vital to support patients’ TB treatment, it has an impact on the services the health centre can provide.
At the Kenyan Medical Research Institute, one of the leading institutes in the country, parliamentarians met with Professor Joseph Nhung’n, a leading infectious disease professor and Executive Director of the Foundation for Innovative New Diagnostics (FIND) Kenya, a close partner of RESULTS UK. Professor Nhung’n spoke about the importance of diagnostics, and highlighted the ongoing fight against COVID-19 as evidence of their importance. When the pandemic struck, resources were diverted away from treatments for other health conditions. Professor Nhung’n also highlighted the impact of global supply chains, explaining that packages of medicines and tests which would normally have taken one week to deliver were now taking as long as two months.
COVID-19 has had a significant impact on the fight to eradicate TB. Given the similarities between the two diseases, many TB facilities were quickly re-purposed to deal with the emerging pandemic. COVID has also occupied a significant amount of global health spending, often at the expense of other diseases like TB. These issues have been silently growing in the background while COVID has grabbed the world’s attention, meaning that there is going to be a significant increase in the amount of TB in coming years, pushing the world even further from achieving our international disease eradication targets.
What are the challenges in tackling TB?
There are many actions and changes needed in order to end TB. On a national level in Kenya, Eric Mose, laboratory technician at Shompole Health Centre, called for logistical changes and better ways to diagnose TB that don't require such complex tests that are currently only processed in a limited number of labs. This would significantly improve the efficiency of TB programmes and would mean that samples wouldn't have to be sent over to other places in Kenya for testing. He also mentioned that TB patients often face stigma, and this can affect their willingness to provide samples for testing.
Dr. Ezekiel Karino, Kajaido County Tuberculosis Manager, echoed the challenge of diagnosis and testing with limited resources and testing sites. He stressed the importance of investments and resources in TB programming, both from the Kenyan Government and donor partners.
What can be done globally?
We find ourselves at a significant moment for the fight to eradicate TB. With one year to go before the next United Nations High-Level Meeting on TB (UNHLM), the international community is still far off track to meet the targets set out at the last High-Level Meeting in 2018. We’re also off the pace to achieve SDG 3.3 - ending the TB epidemic - by 2030.
A major issue is the funding and resourcing gap needed for TB, which has been exacerbated by the COVID-19 pandemic. The UNHLM set a target that by 2023, TB will receive $13 billion annually for treatment, diagnosis and prevention programmes. As it stands, there is a $6.5 billion gap for achieving that target and that figure doesn’t take into account the setbacks from the pandemic.
The Global Fund to Fight AIDS, TB and Malaria provides the majority of all international financing for TB. TB patients, survivors and advocates around the world mobilise around Global Fund replenishments to urge governments to make financial pledges towards its work. In the coming months, we will be calling on the UK Government to commit funding to efforts to end TB, including a generous pledge to the Global Fund ahead of the 7th replenishment campaign.
The information, experiences and stories shared by our friends and partners in Kenya is a powerful reminder of why we advocate for efforts to eradicate TB, and how our advocacy in the UK is aligned with that of advocates around the world. So this World TB Day, let’s raise awareness of TB, listen to and amplify the voices of those affected by the disease and together, call for action to end TB.