Treating TB During the Time of COVID-19
Tuberculosis (TB) causes more deaths than any other infectious disease in the world, and Namibia has one of the highest TB infection rates in the world. In 2018, an estimated 13,000 people in Namibia fell ill with TB, and more than 5,000 of these were not diagnosed. This is particularly worrying during the COVID-19 pandemic because both TB and COVID-19 affect the lungs. Globally, there is mounting evidence that patients with chronic respiratory diseases, including TB, are at increased risk for severe illness or dying from COVID-19.
Global estimates suggest that unless additional measures are put in place, the lockdowns that have been implemented across the world to prevent the spread of COVID-19 infection, and the slow return to services after these lockdowns, could lead to an additional 6.3 million cases of TB during 2020–2025 and an additional 1.4 million TB deaths. This will set the world back five to eight years in the global fight against TB.
To ensure TB patients continue to receive care during the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention country office in Namibia (CDC Namibia) is supporting the Ministry of Health and Social Services (MoHSS) to put in place measures to continue fighting HIV and TB while helping reduce exposure to COVID-19 in healthcare facilities.
Medical illustration of drug-resistant, Mycobacterium tuberculosis bacteria, presented in the Centers for Disease Control and Prevention (CDC) publication entitled, Antibiotic Resistance Threats in the United States, 2019 (AR Threats Report). Medical Illustrators: Alissa Eckert; James Archer
Community health workers lead efforts to protect patients from TB and COVID-19
Community health workers (CHWs) are leading these preventive measures by providing more TB services to patients where they live, reducing the number of visits these patients need to make to their local clinic. This reduces patients’ chance of exposure to COVID-19 at healthcare facilities if the virus starts to spread within communities. The MoHSS has linked each patient to a specific CHW to ensure that all patients with TB receive the care and support they need. The CHW acts as a focal point for the patient, providing information, support, and healthcare screening for TB and other illnesses. The CHW also collects any medicines the patient may need from the clinic, again reducing the risk of exposure to COVID-19. Patients who do need to visit a healthcare provider are asked to visit a smaller, less busy facility, which helps to maintain social distancing.
Providing more services in the community is something we will continue post-COVID-19.
“Providing more services in the community is something we will continue post-COVID-19,” says Albertina Thomas, head of the National TB program at the MoHSS. The Ministry was already scaling up community services, and since the COVID-19 pandemic, we have worked hard to roll out these services faster. Community healthcare services are more convenient for patients who need medicine refills and other simple support services. COVID-19 has brought many changes, and some of these changes are here to stay. Therefore, interventions, such as digital technology to support TB treatment adherence, will be considered during the envisioned ‘new normal’.
MoHHS takes steps to reduce risk of COVID-19 and prevent TB
People living with HIV are at increased risk for TB infection and might also be at increased risk for severe illness from COVID-19, based on what is known at this time. To reduce these risks, the MoHSS is prioritizing the identification of people with HIV who need to take a course of TB preventive therapy (TPT), medicines that reduce the risk that TB infection will develop into active TB disease. All HIV-positive patients should take this medicine for a period of six months to reduce the risk of TB disease. To minimize visits to clinics, HIV-positive patients are now provided with the full course of TPT medicine when they start the TPT treatment. Later this year, the MoHSS will introduce a shorter course TPT regimen that needs to be taken for a period of 12 weeks only. This regimen will be much more convenient for patients, making it easier for them to complete the full course.
Community healthcare workers are also working hard to identify any other person who should be given TPT. For example, if a person with TB disease is living in a household with children under the age of five, these children will also be given TPT. Despite the COVID-19 pandemic, preventing the development of TB disease in Namibia has remained a priority.
“We are doing everything we can to continue to prevent and treat TB and slow the spread of COVID-19,” said CDC Namibia Country Director, Dr. Eric Dziuban. “Keeping as healthy as possible is important to be prepared to fight off other diseases. We have worked with the Ministry to raise awareness about TPT and HIV-positive patients can do their part by asking about TPT if they have not yet been given this medicine, and when they are given the medicine, making sure that they take the pills every day for the whole six-month period. By reducing the risk of TB disease, HIV-positive patients will also help protect themselves from developing the most severe symptoms of COVID-19 infection if they catch the virus.”
Continuing to provide essential care and treatment
The International Training and Education Center for Health of the University of Washington (I-TECH/UW) is one of the heath development partners supporting the MoHSS to identify and manage patients who need to receive TPT. Despite the lockdown from 27 March–4 May 2020 and continued restrictions in parts of the Erongo region, I-TECH has worked hard in supporting the MoHSS to ensure that patients eligible for TPT receive their medicine.
‘’We are pleased to continue providing direct service delivery and technical support to the Ministry during these challenging times of the COVID-19 pandemic,” said I-TECH Country Director, Dr Norbert Forster. “With the MoHSS resources stretched to the limit, I-TECH is committed to continue our support. We need to prevent a backlash of diseases like TB and HIV/AIDS after COVID-19 has passed. It is therefore hugely important that services for these conditions must continue without interruptions.’’
We need to prevent a backlash of diseases like TB and HIV/AIDS after COVID-19 has passed. It is therefore hugely important that services for these conditions must continue without interruptions.
In Namibia, the steps taken to ensure that TB patients continue to be cared for, and that new TB infections are prevented, will have a vital impact on preventing an increase of new TB cases in Namibia. TB and HIV patients are safer because of the measures that the MoHSS and its partners have put in place.
Collecting four months of medicine: Stepping up HIV patient care during a global pandemic
When borders are shut: Providing ART medicine to all patients during the COVID-19 pandemic
Voices from the Field: An interview with Dr. Eric Dziuban, CDC Namibia Country Director
Voices from the Field: An interview with Anita Beukes, Laboratory Advisor