By Sylvia Chebet
Peter Muchui learned the hard way the consequences of skipping his medication, ending up taking 16 tablets daily for 18 months after contracting the deadly multi-drug resistant TB (MDR-TB).
A few months after he was given a clean bill of health, a shortage of TB drugs struck Kenya's hospitals. As he contemplates what might have been, Muchui can't help but acknowledge how lucky he was to survive.
"As we talk right now, there are no drugs. You can imagine someone on a six-month course of medication missing treatment even for a day. That person's system has automatically created MDR-TB," Muchui, now an anti-TB ambassador, tells TRT Afrika.
Having covered 15 out of 47 counties in Kenya and interacting with patients, doctors and caregivers, he knows exactly where things go wrong.
"I create WhatsApp groups in every county I visit. All of those groups are reporting the same thing. There are no TB drugs," says Muchui.
It pains him that some of the patients currently on treatment may have developed resistance to medication due to supply issues.
"We have no clear answers as to why we have a shortage of essential TB drugs. I know where the shoe pinches and how it pinches. It pains me that we may lose lives because of this," he rues.
Stronger strains
A patient develops MDR-TB when the body becomes resistant to the first line of TB treatment, putting the person at yet another serious risk of an extensively drug-resistant strain, or XDR-TB.
The latter condition strikes root when the system also rejects the second line of medication.
Drug resistance to TB treatment is mainly caused by interruptions in treatment, the most undesirable occurrence for patients and a monumental challenge for doctors.
Muchui recalls how he stopped medication in 2017, two weeks after starting treatment. His reason? "I felt well," he says, in hindsight flinching at the folly of his decision.
Unbeknown to him, Muchui's body had by then strayed into the challenging world of MDR-TB.
"The condition hit me with full force. I was losing weight (down to 45 kg from 65kg) every day. My bed would be drenched in sweat each morning; you could squeeze water out of my bedding," he recounts.
Instead of the three tablets a day he had been prescribed initially, Muchui's dose of medication increased more than five-fold.
He also needed an injection daily for six months. A clinician from his Kasarani neighbourhood on the outskirts of Nairobi came to his home every day to administered the treatment. "I was sore from the injections; I couldn't even tell whether it was the left or right side that had been jabbed the previous day. I would sleep for at least two hours after medication," says Muchui.
After completing his injection cycle six months later, he inexplicably discontinued the oral medication again.
It was a mistake that took him back to where he had started from. The engineering graduate had to shut his second-hand clothes business.
It was a painful reality for a man in his mid-thirties who had just become a father. "I gave up on life. My parents took me to see other specialists and even for special prayers, but my health kept deteriorating. Finally, I returned to my senses and reminded myself that I have a family to feed and a daughter to raise," he says.
When he returned to the clinic, the doctor spelt out that the duration of treatment would be doubled as per the WHO recommendations at the time.
"Every day, for 18 months, I took 16 tablets at 11am on the dot. If I had to travel, I would have to take a video of myself taking the pills and send it to my doctor," Muchui says of the drill.
He was declared TB-free in December 2022. Having battled the disease for nearly five years, he became a fighter against TB.
Treatment challenges
Transitioning from regular TB treatment to MDR-TB treatment is challenging, as Muchui would testify. Doctors say default rates are higher among patients who develop resistance.
The current drug shortage has Muchui worried about what the combined factors could lead to. "In just the next two to three months, where will Kenya be?" he says. "And to think we have been fighting to eliminate TB by 2030."
The latest Global Tuberculosis Report released by WHO on November 7 shows that an estimated 10.6 million people were infected with the disease worldwide in 2021, up from 10.1 million in 2020 and reversing many years of slow decline.
The Covid-19 pandemic has had a damaging impact on access to TB diagnosis and treatment and the burden of TB disease, according to WHO. "Progress made in the years up to 2019 has slowed, stalled or reversed, and global TB targets are off track," states the report.
The most obvious impact has been a substantial reduction in the reported number of patients newly diagnosed with TB in both 2020 and 2021, suggesting an increase in the figures of people with undiagnosed and untreated TB.
In 2021, the estimated number of deaths caused by TB was more than double the number caused by HIV/AIDS. "Shortly, TB may once again be the leading cause of death worldwide from a single infectious agent, replacing COVID-19," the WHO report states.
Reversals in progress in the number of people enrolled on treatment mean that the global targets set at the UN high-level meeting are increasingly out of reach.
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