Hold patients in special isolation units not jails as TB is not a crime, judge orders

Daniel, 40, was diagnosed with pulmonary tuberculosis in January 2010. With a week’s dose to treat the respiratory disease, he was sent home without adequate information on what ailed him.

“When the medication was over, I was not aware I was meant to go for more. So I stayed home until my condition worsened, leading to confrontations with the health workers when I returned to the health facility near my home in Kapsabet,” Daniel, a  father of five, told The Standard on Sunday.

This scuffle led to his incarceration at Kapsabet remand prison with his brother Patrick Kipng’etich, who had also defaulted on his TB treatment.

A third brother, Henry, was also meant to serve time for defaulting treatment but was too sickly.

While he doesn’t dispute that he failed to follow up on his TB treatment, Daniel says the inadequate public health information on the management of the disease led to his imprisonment to complete the eight-month treatment in prison.

“We slept on the cold cement floor and were held in congested rooms. The food was inadequate,” he said.

With the help of the Kenya Legal and Ethical Issues Network on HIV & AIDS (Kelin), Daniel and Patrick were released after 46 days to complete their treatment at home.

In a petition, Daniel, Patrick and Kelin sought to challenge the wide spread practice adopted by public health officers to confine TB patients in prison for treatment. “Holding TB patients in prison not only puts a risk to the other prisoners but to the prison wardens and their family members. It also defeats the very aim the health officers seek to achieve - protect the public from persons with infectious diseases,” reads part of the Kelin petition.

Thanks to this petition, the High Court has declared confinement in prison of TB patients who are not willing to take medication unconstitutional.

In a land mark ruling made on Thursday, and as the world commemorated the World TB Day, Justice Mumbi Ngugi ordered the Ministry of Health to publish new policy guidelines on how patients with infectious diseases should be handled within 90 days.

In her judgement, Ngugi also gave the government 30 days to issue a circular to all hospitals and other health centres that the law does not allow health officials to arrest and imprison TB patients who have refused to take medication.

“Given the state of prisons in the country, which are mostly overcrowded, they are not the right isolation centres to confine TB patients,” she said.

Earlier that day, Daniel, Patrick and Peter had joined thousands of advocates seeking to destigmatise and speak out on the deplorable prison conditions for TB patients in a march to mark the World TB Day.

“Tuberculosis is not a crime. Specialised isolation units are better ways to ensure patients who default on treatment complete it within the stipulated time,” said Daniel.

The World TB Day is marked annually on March 24 to commemorate the day in 1882 when Dr Robert Koch announced he had discovered the TB bacillus that causes tuberculosis.

Head of the National Tuberculosis, Leprosy and Lung Disease programme (NTLD) Enos Masini said this year’s theme, ‘Mulika TB! Maliza TB’, was meant to spread awareness on the respiratory disease, especially in vulnerable populations like persons with HIV, prisoners, health care workers and those residing in poor urban settings.

Globally, the fight against TB has been complicated by resistance to drugs, thus patients are placed on more expensive drugs requiring strict adherence.

According to Dr Masini, 82,000 persons have been treated for TB whereas another 436 are on treatment for the multi drug resistant (MDR) type.

“The main causes of TB resistance to drugs are failure to adhere to treatment, poor choices of drugs, and use of sub-standard drugs,” Dr Masini told The Standard on Sunday.

For MDR TB, Kenya has successfully treated 1,600 patients who were on treatment for at least 20 months in a regime that included eight months of injections alongside oral medications at a cost of Sh1.5 million each.

Kenya has had five cases of extensively drug resistant TB (XDR) TB; one was cured, two are on treatment while the other two died from the complications of this extreme form of the disease that costs Sh2 million to treat per patient for a period of two years.

Resistance to anti-TB drugs occurs when these medications are misused or mismanaged, especially when patients do not complete their full course of treatment

MDR TB is caused by an organism that is resistant to the two most potent TB drugs whereas XDR TB is a rare type that does not respond to both the first line and second line TB drug.

Dr Masini underscored the importance of sharing basic health messages to ensure timely diagnosis and treatment of TB.

In February, International medical humanitarian organisation Médecins Sans Frontières expressed concern over the high price announced for one of the new drugs used to treat a resistant form of the new TB drug, adding that for the fight against the disease to be won, countries should scale up treatment for more people with drug-resistant TB using the most effective drugs available.

Scientists are working on shorter-course TB drug schedules from the current six-month treatment course to ensure adherence to treatment.