TB testing, treatment disruptions spark fears of rising HIV deaths

A patient is examined with an Artificial Intelligence(AI) equipment while marking TB Day in Kutus town. [File, Standard] As the world observes World TB Day today, there is little to celebrate as Kenya grapples with significant challenges in TB testing and sample transportation following the recent stop-work order from US President Donald Trump. Trump's decision has sparked fears of increased AIDS-related deaths among people living with HIV. In Kenya, TB remains the leading cause of sickness and death among individuals living with HIV. However, with disruptions to services and the integration of HIV care into general health services, TB is going undiagnosed. Nelson Otwoma, Executive Director of the National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak), stated that TB testing has been severely impacted. "With the disruption, we expect cases of Advanced HIV Disease (AHD) to rise dramatically," Otwoma lamented. The US government, through the Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR), has been instrumental in supporting TB care for HIV patients. Their efforts have included case identification at both facility and community levels, as well as strengthening diagnostic and laboratory networks to ensure timely testing. However, with the stop-work order, these critical TB-related activities have been abandoned, putting thousands of lives at risk. "With USAID disrupting diagnostics and laboratory networks, along with the collapse of sample transportation, TB is not being diagnosed," Otwoma explained. According to Otwoma, people living with HIV need to be screened for TB during every visit to the facility. Before the donor's pullout, the Comprehensive Care Unit (CCC) was responsible for TB screening, collecting samples, diagnosis, and referring individuals with TB for treatment. However, with the integration of TB services by the Ministry of Health following the stop-order, screening is no longer taking place, putting people at risk of death and infection from the highly contagious disease. Data from the Ministry of Health shows that at least 40 per cent of individuals with new HIV infections are presenting with Advanced HIV, previously known as AIDS. In 2024, the country recorded 20,460 AIDS-related deaths, representing a significant reduction of 68 per cent since 2010. However, this figure marks an increase from 18,473 deaths in 2023. These deaths are attributed to TB, diarrhoea, malnutrition, and other infections. "We are likely to see trends that we thought were long gone, where people living with HIV were dying with little chance of survival. The fact that these deaths can be prevented through TB testing and treatment-why aren't we acting as a country to prevent these deaths?" Otwoma said. At least 1,378,457 Kenyans are living with HIV, of whom 1,336,681 are on treatment, with a seven per cent rate of mother-to-child transmission. Counties with the highest HIV burden include Kisumu, Homa Bay, Migori, Nairobi, Nakuru, Mombasa, Kiambu, Kakamega, Kisii, Machakos, Uasin Gishu, Busia, Kilifi, and Kitui. The World Health Organisation (WHO) has already warned of a surge in TB cases and deaths across Africa following the stop-work order. Speaking at the Africa Health Agenda International Conference (AHAIC) in Kigali, Rwanda, Dr Chikwe Ihekweazu stated that most Stop TB Partnership programmes in Africa are supported through USAID. Eveline Kibuchi, the Stop TB Partnership Kenya Country Coordinator, expressed regret that co-infection rates in people living with HIV had been reduced from around 39 per cent ten years ago to the current 23 per cent. "We were making excellent progress in reducing TB infections among people living with HIV. We achieved this by introducing TB prevention therapy for individuals living with HIV, reducing their chances of contracting TB," she said. Currently, TB testing and other services have not resumed due to the significant support previously provided by the US government. With US support, sputum samples for TB testing were transported from satellite clinics to GeneXpert sites, but with the stop-work order, this transportation has ceased. "In some instances, sputum samples are not transported or stored properly because they risk being destroyed. Only patients near GeneXpert facilities are receiving diagnoses," Kibuchi told The Standard in an interview. Sadly, despite these concerns, the Kenyan government has yet to implement solutions to address TB, despite plans to eliminate the disease by 2030. The government currently funds only 9.7 per cent of TB services, with 90 per cent of funding coming from donors. This donor funding supports active case finding, treatment, community-level education, addressing stigma, digital X-ray screenings, and sputum transportation networks. The 90-day aid freeze, enacted in January, has thrown the global medical supply chain into turmoil, blocking the distribution of drugs that have already reached their intended countries to fight HIV and other diseases.

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