Mosala Masinyale first found out he had TB in 2004, when he came back home to Lesotho after working in the mines in South Africa for over 30 years. A few months after completing the full course of TB treatment, Mosala started coughing again. "It was worse than the first time because I was coughing blood. Then I came back to the clinic to get tested again." This time, Mosala was diagnosed with multi-drug resistant (MDR) TB.
MDR and extensively drug-resistant (XDR) TB are serious problems throughout South Africa, including in provinces neighbouring Lesotho, and the constant migration between the two countries means we can expect to see similar rates of drug-resistant (DR) TB in Lesotho. In late 2006, MSF took initial steps to improve diagnosis of DR TB.
This started with establishing a reliable system to send specimens out of the country to a laboratory in South Africa to detect drug resistance. As of the end of August 2007, MDR TB has been confirmed in 17.5% of the "culture positive" samples tested in patients suspected of having DR TB. At the national level, Lesotho itself is making major strides to improve capacity to diagnose and treat DR TB, thanks in large part to major support from Partners in Health and other actors. However it is clear that given the ever-increasing numbers of patients, a more decentralised approach to MDR TB management – diagnosis and treatment - must be explored. This is a major challenge given the archaic therapeutic tools available to treat MDR TB, which cause frequent and severe side-effects and require daily injections for six months and an overall duration of treatment that can be up to 24 months. If a person is HIV-positive, treatment of co-existing tuberculosis is even more complex, requiring additional drugs and monitoring.
Mosala is receiving the first phase of his MDR TB treatment as an outpatient at one of the clinics where MSF supports nurses and "lay counsellors" in providing integrated HIV/TB care and treatment. "Every morning, I come here for my medication. I take a very painful injection and 12 tablets everyday", said Mosala.
When he arrives at the clinic, he is often seen straight away by the nurse, who monitors his health condition and gives him his tablets and the injection. Now that he has been on treatment for six months, he is no longer coughing, but when he was, he knew he had to stay outside the clinic and avoid contact with other patients. to reduce the risk of transmission of MDR TB. Making sure that TB patients who are coughing do not sit in the small waiting rooms together with other patients is part of a package of simple, "low-tech" measures being taken to improve infection control.
Despite the challenges of following such long and difficult treatment, Mosala is motivated to continue, as he feels better by the day: "The treatment that I get here has been very good. It has given me strength and a life. I think without it I would be dead by now". Alessandra Vilas Boas