DOT initiative makes huge impact in fight against TB

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Alvine Kapitako

Tsumeb-In May this year, 46-year old Hendrich Khaibab was diagnosed with tuberculosis, an airborne disease. “I don’t know how I got TB but when I would walk to work each morning I would feel pain in my chest and I decided to seek medical attention,” said Khaibab, a first-time TB patient.

Khaibab receives his TB medicine every morning at the TB-Directly Observed Treatment Center (DOT), a service delivery initiative that became operational in Kuvukiland towards the end of July last year.

The TB-DOT service delivery initiative is funded by the U.S. Government through the President’s Emergency Plan For AIDS Relief (PEPFAR ), the United States Agency for International Development (USAID) and is implemented by Koninklijke Nederlandse Centrale Vereniging (KNCV) Tuberculosis Foundation in collaboration with the Ministry of Health and Social Services.

“This is close to home so I just walk here,” said Khaibab who coughed persistently throughout our interview. He is one of many patients at Kuvukiland who can now access health services within a walking distance from their homes.
The number of patients with TB who had defaulted on their medication in Kuvukiland informal settlement in Tsumeb reduced drastically from 21.5 percent to 7.6 percent when TB health services were brought closer to the people, according to Sylvia Haoses, who is also the Tsumeb district TB and leprosy coordinator.

“There was a high lost-to-follow up rate, interrupters on TB treatment were really high,” said Haoses, a registered nurse.

She attributes the notable decline in patients who stopped adhering to their TB treatment to the fact the DOT point is nearer to the people of Kuvukiland, which is home to more than 7,000 people.

“Sometimes a person that is sick is not really fit enough to walk a long distance just to come and get their daily medicine or injection,” said Haoses.

TB patients are extensively monitored so that they adhere to the treatment, Haoses explained. “That monitoring was a challenge for us at the clinic but since the DOT came here this is one of the places where patients are cured because they have completed their treatment,” she added.
The informal settlement has a high TB rate, added Haoses.

Being an informal settlement, overcrowding is a contributing factor to the high rate of TB in Kuvukiland, said Haoses.

“TB is an airborne disease so overcrowding there is contributing. If you see their houses you would notice they have poor ventilation so that’s already a contributing factor,” said Haoses.

“Some people’s immune system is compromised [weak immune systems due to malnutrition and other diseases] and it is easier for a person with a compromised immune system to contract TB,” said Haoses.

Fortunately, the DOT point has not yet recorded a case of multi-drug resistant TB. “But we have come across previously treated TB patients,” she added.

Those are patients who have gone through TB treatment and completed it but acquired the disease again.
The clinic also records a number of cases in which TB patients have not finished their treatment, and those that have failed on maintaining treatment or those that have interrupted their treatment, she explained.

“Those are the risk factors for multi-drug resistant TB. We want to prevent the risks of drug resistant TB. So this DOT has had a great impact,” said Haoses. There are also cases of TB coinfections at the DOT.
U.S. Ambassador Thomas Daughton in March stressed the need to provide comprehensive TB and HIV services in Namibia.
“Namibia has one of the highest HIV-TB coinfection rates in the world,” he said then.

That means that on average about four out of every ten patients with TB are also HIV positive. In the case of the DOT point in Kuvukiland, patients also have access to HIV services at the next container that was made possible with support from Intrahealth.

Before the DOT point became operational, a lot of public meetings were held and information sent out on the plans to start the DOT point.

“Patients come by themselves or through public education. We go into the community where we sensitise the community about this container so that they take ownership,” said Haoses.

The clinic is operational from 07:00 to 16:00. “It’s for the patients’ convenience because some of them start at eight and come back at 17:00 – so they can quickly come here before they go to work,” explained Haoses.

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