Since late last year, Gloria Kendi, a 26-year-old mother of one living in the Mathare North area in Nairobi County had been struggling with a persistent cough and nagging pain under her rib cage.
She was pregnant at that time and was afraid of buying over-the-counter drugs. However, the fact that she was not getting better was cause for concern for her husband Antony Njenga who advised her to go to the hospital.
After several tests, she was asked to go for a chest x-ray to see why she had that pain under her rib cage. She was diagnosed with tuberculosis using a digital chest x-ray that showed that the infection had spread to her lungs.
“It was not an easy journey for me. I had a pre-term birth at seven months and then they told me I had to begin TB treatment. I did not have appetite and considering I had to nurse my baby, I lost weight and even began to believe that I wouldn’t make it,” Kendi says.
Her husband Njenga was informed that he had to be put on TB preventive therapy that he was to take once a week for three months and their newborn son to take a dose daily for three months as well as a way of protecting them from infection.
“I feel this preventive therapy is good for the patients to fight stigma because when I was taking mine, Gloria would feel at ease while taking hers and I believe this will help deal with stigma for people with TB, they will no longer be locked in their rooms and told not to share basic household items because everyone will feel protected,” he said, adding that families need to be supportive and not discriminative.
Although Gloria was afraid of the stigma, especially from her friends, she says she was also careful not to infect anyone and would be extra careful when handling the baby to ensure there was no transmission to him.
According to medical experts handling tuberculosis cases in the country, there is an improvement in the response to tuberculosis in the country since the launch of Introducing New Tools Project (iNTP). Kenya was one of nine high-burden countries in Asia and Africa where the project was introduced last year.
Medics say the new tools have helped in easier and faster diagnosis including edging towards finding the 40 per cent of missing cases thereby reducing further community transmission of TB.
This includes new tools in TB screening, diagnosis and treatment such as the treatment courses for TB preventive therapy, the True Nat point-of-care nucleic acid amplification test, the portable digital Chest X-ray equipment, the interferon-gamma release assay (IGRA) machine, medication sleeves and connectivity solution for all TB diagnostic equipment.
“Ruaraka area which is an informal settlement has a high burden of tuberculosis. In 2021, it reported a prevalence of 1,234 cases but after the introduction of the digital chest x-ray, the cases increased to 1,307 which is a 6 per cent increment,” said Nelly Nyaboke the TB Coordinator in Ruaraka, "the x-ray with a computer-aided detection software (CAD) has helped us find the missing cases.”
She says the machine can trace people who have no symptoms of TB but have been infected.
According to Caroline Macharia, a radiographer in Mathare North Hospital, the x-ray machine will display wounds on the chest and lungs.
"This is used to diagnose the patient, and since it is a digital machine, it means the results are instant,” she says. The new x-ray machine is better than the older versions of screening for TB such as sputum test microscopy which would miss out on some cases.
“Back in the day when we used to rely on the old x-ray machines and other methods, we would miss so many cases, and also it would take many days before getting the results,” said Patrick Maingi a chest clinician at Rhodes Chest Clinic in Nairobi.
He however recommends the use of multiple tools in diagnosis, such as a combination of the chest x-ray and the GeneXpert which can detect if a patient has drug-resistant TB or not.
In addition to the use of the GeneXpert, one of the tools used in screening and diagnosing tuberculosis, the Ministry of Health with support from USAID has also introduced the use of Truenat which is more advanced in testing.
This is a chip-based molecular test for TB which is battery-powered to operate in peripheral laboratories and can generate results in one hour.
In addition to fast detection of tuberculosis, it can detect resistance to Rifampicin in an additional one hour, meaning that if a patient is detected to have this strain that is resistant to Rifampicin, they will be put on the right medication.
“Truenat availability in facilities has improved access to TB testing for patients with signs and symptoms of TB, especially in hard-to-reach areas where sample referral systems are unavailable or not properly constituted. It has a short test turnaround time reducing overall test turnaround time and time to TB treatment,” Kennedy Muimi, Senior Technical Officer Laboratory, CHS.
Among the 38 Truenat machines spread across some selected areas which have high TB prevalence in the country, one is in Lari Level 4 hospital in Kiambu County which has improved on case finding and treatment.
Kiambu County is among the top five leading counties in the country with a high TB prevalence of 166 per 100,000 cases by 2022. With the new equipment, the medics have been able to find more missed cases as compared to previous times.
According to Loise Gikonyo the Laboratory Technician at Lari Hospital, the machine can serve more people in remote places because it is portable.
Medics advise that if one is diagnosed with TB one ought to be initiated on TB treatment immediately to prevent further spread in the community. Additionally, their families or close contacts are also put on TB preventive Therapy for three months whereby they are not able to be infected even if they interact with an infected person.
According to Patricia Mwangi the Lari Sub-County TB Coordinator, this kind of therapy was first piloted in Kiambu County following a study that was conducted in 2019 showing that 80 per cent of healthcare workers there had latent TB, one where a person may be infected but has no symptoms.
“There are people who may inhale the micro bacterium and since their immunity is strong, they will only show symptoms if their immunity is compromised.”
The Interferon-gamma Release Assay (IGRA) machine is used to detect TB at latency where one is initiated on this preventive therapy.
The Ministry of Health has identified people who are eligible for this preventive therapy which includes healthcare workers, household contacts of people who have been diagnosed with active TB and prisoners.
Others include people living with HIV and people going through cancer treatment because their immunity is compromised.
According to Mwangi, the therapy constitutes a combination of Rifapentine and Isoniazid which is administered in three tablets taken once weekly for three months for adults with children below 14 years taking Rifampicin and Isoniazid daily for three months.
The Ministry of Health launched the New TB Tools Project (iNTP) for screening, diagnosis and prevention to accelerate the national response to eliminate TB by 2030. Kenya is among seven countries in the world to receive such support from USAID.
“The Ministry of Health in line with the Kenya Kwanza manifesto is committed to improving health care in the country through the adoption of the latest technology. To accelerate and strengthen TB control, the Ministry through the National TB Program and in collaboration with its partners has rolled out the use of the latest WHO-approved TB diagnostic tools through the Introducing News Tools Project. Among these diagnostic tools rolled out across various counties are 38 Truenat machines,” Dr Josephine Mburu, PS, Ministry of Health, State Department for Public Health and Professional Standards said.
“The U.S. Agency for International Development is proud of the positive impact the introducing New Tools Project has had in diagnosing tuberculosis, and I applaud the Government of Kenya for continuing to invite new technologies to address TB challenges. In partnership with the Kenyan government, USAID will continue to promote targeted community outreach and increase private and public collaboration to find and treat undiagnosed TB cases,” John Kuehnle, Director, USAID Health Population and Nutrition Office.
Currently, there are 38 Truenat kits, 8 portable chest x-ray machines, 2 IGRA machines with medication sleeves for 5000 patients with the digital adherence technology and preventive therapy regimens for 13000 people as well as the connectivity solution for all TB diagnostic equipment.