Anne Juma had some uninvited guests at her Githurai home in Mtwapa, Mombasa County. She could see her neighbour Amina, leading three official looking men to her house. She had an inkling as to why they were looking for her, but was not too sure so she quickly moved to the back room of her house. Hiding. Listening.
From her hiding place, Anne could see her neighbour, Amina, make a beeline for the backroom where she was hiding. She briefly considered escaping through the window but quickly thought otherwise.
Before she knew it, Amina was at her side. “Anne, please come and talk to your visitors. I promise you they are not here to harm you. If anything, they are very concerned about your health.”
Reluctantly, Anne stood up and limped to the front room with Amina’s support. Anne’s right leg had been giving her problems lately.
She found the three men sitting on the faded grey plastic seats in her front room. Amina helped her to the only other remaining seat where she sat and looked at her visitors suspiciouly.
In the awkward silence, one of the men started talking. “My name is Yakubu Ali from Shimo La Tewa Health Centre. These are my colleagues Janja and Godana.”
The awkward silence persisted.
Yakubu braved on. “We are here because we wanted to see how you are fairing on. You were under our care for Multi- Drug Resistant (MDR) TB but we have not seen you for more than one year. What happened?”
Suddenly, a baby started wailing loudly from the back room.
Amina, the neighbour, quickly dashed to the backroom and emerged with a baby of about eight months. Amina handed the baby over to Anne who instinctively cradled the baby in her arms. Slowly, the suspicious façade on Anne’s face faded away and she begun speaking softly. “I got preganant in early January 2013 and had severe nausea. I kept throwing up the drugs and so decided to abandon the treatment.”
This was not the first time Anne was interrupting her treatment.
Anne was first diagnosed with TB in early 2004 and put on treatment. In February of the same year, she abruptly travelled to her rural home in Nyanza without her drugs and her appointment cards. Since she could not access any of the TB medication she was on while at her rural home, Anne stopped taking the required medication.
Eight years later, Anne was back at the Coast and quite unwell. She again visited the local clinic and gave her sputum for culture tests and Drug Sensitivity Testing (DST). Anne was subsequently diagnosed with MDR TB and initiated on treatment which she took for about one year and one month.
Then she disappeared again.
In Kenya, the MDR-TB burden is estimated at 3.1% of new and 10% of retreatment cases. In 2011, 166 MDR-TB cases were confirmed in Kenya and by 2013, 248 cases of MDR-TB were identified and started on treatment.
In the Coast, four MDR TB clients including Anne have been lost to follow up. According to Anne, she interrupted her treatment due to the pregnancy and also because she lacked social support.
“I did not have any money to commute to the health centre and could not take the TB drugs on an empty stomach.” Anne told the public health officials who visited her.
Clients on MDR treatment often need a social support structure if they are to succesfully adhere to their treatment. The USAID funded Tuberculosis Accelerated Response and Care (TB ARC) activity has a detailed plan of action to scale-up the availability of social support to MDR TB clients across the country. This social support includes nutritional support and transport reimbursement for patients to travel to health facilities as well as support to health care workers to facilitate home-based Directly Observed Treatment (DOTs).
Without this kind of social support, MDR clients like Anne can easily slip through the cracks and continue to transmit the drug resistant strain of TB. Through TB ARC support, Anne can now access some funds every month to travel to the nearest health facility for treatment and buy some food for herself and her family. TB ARC further supports MDR clients like Anne to access high quality laboratory investigations to keep track of their progress.
With social support structures in place and proper clinical management structures set up, Anne and many other MDR TB clients in the country can reclaim their health and contribute to a more prosperous and healthy society.