In a desperate time, Zimbabwe gambles
In a desperate time, Zimbabwe gambles
Despite poverty, antiretroviral therapy planned
Fighting TB in resource-poor African countries hard-hit by HIV must seem like stuffing a thumb into a leaky dike. The sheer numbers of AIDS and TB cases alike grow more astonishing by the day. By 2005, the latest U.S. intelligence analysis suggests, HIV-infected cases in Africa will likely be double what they are today, thanks to logarithmic growth in the epidemic now occurring in two populous countries, Ethiopia and Nigeria.
That raises the specter that by 2005, there will be more than 60 million adults in Africa infected with HIV.
New TB cases soar tenfold
As the epidemic churns across the continent, a conflagration of TB trails in its wake. In Zimbabwe, as one of two or three countries vying for the unenviable title of "nation hardest-hit by HIV," newly diagnosed TB cases have soared tenfold in the past ten years, from 5,000 cases a year to 50,000.
Like most other African countries that are struggling with HIV, Zimbabwe is poor, with a per capita income of under $1,000; accordingly, there are scant resources available for fighting TB and HIV. Botswana and South Africa, also extremely hard-hit, are the two exceptions, with economies placing them on a par with Brazil.
Predictably, Zimbabwe’s poverty has crippled the national expansion of directly observed therapy, short-course (DOTS), the treatment strategy for TB approved by the World Health Organization (WHO). According to Michael St. Louis, MD, director of the Centers for Disease Control and Prevention’s CDC/Zimbabwe AIDS program, nearly one-third of the microscopes in the country have sat broken and useless for years, with no money available for missing parts. In the same way, the cost of transporting supplies and providing supervision has meant that other components of a functioning DOTS program are only partly functional.
To add to the country’s TB-related misery, the Netherlands — historically a generous donor with a wealth of TB expertise — has pulled out of both Kenya and Zimbabwe, citing concerns about corruption and human rights violations. The Dutch pullout "is having a major impact on TB programs in Kenya and Zimbabwe," says St. Louis. "Right now, there’s no one on the horizon to take their place."
During recent elections, nightly press coverage featured a stream of images of village chiefs proclaiming to campaigning politicians that they required one thing above all others: help in coping with the AIDS epidemic.
The government seems to be listening, St. Louis says. Along with the traditional approaches to taming the co-epidemic — that is, continuing to strengthen DOTS and offering cotrimoxazole (Bactrim) prophylaxis for opportunistic infections other than TB — the health ministry has announced it will pilot antiretroviral therapy, a step once thought to be far too extravagant for so poor a country to attempt.
Serving as technical advisor, St. Louis is helping formulate guidelines for the pilot project. Under his direction, work has also begun to repair the country’s tattered microscopy system and shore up its national TB reference lab. The network of volunteers who carry out home-care visits for AIDS victims is also being enlisted to give directly observed therapy to TB patients, St. Louis says.
Finally, cotrimoxazole prophylaxis has been embraced enthusiastically, though it hasn’t yet proven its effectiveness here because resistance to the drug hampers its efficacy in some regions, St Louis reports. "People like very much having some positive step they can take," he notes.
Generics help just by existing
Will antiretroviral therapy prove to be feasible in so poor a nation? It helps that the Global Fund to Fight TB, Malaria and AIDS recently gave the country a modest grant for treatment programs, St. Louis says. Although the country won’t purchase drugs from a generic maker, the mere existence of generic AIDS drugs has helped bring the price of antiretrovirals down a little, he adds. "Generics have really started the dialogue that has helped bring down prices," he says.
Zimbabwe’s decision is only a tentative first step so far. But it may offer a look at the future of the co-epidemics of TB and HIV for the rest of sub-Saharan Africa. No matter what happens, the fact that Zimbabwe is determined to try a first-world solution reflects exactly how desperate the situation has become.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.