World TB Day has a special meaning for me, and it is not just because of my job as a USAID Health Officer in Kazakhstan. It is because every morning for the past four months I have taken a daily isoniazid pill to treat my latent tuberculosis.
Tuberculosis, or TB, is a contagious chronic bacterial infection that is spread through the air and usually infects the lungs. More than 2 billion people—one-third of the world’s total population—are infected with TB bacilli, the microbes that cause TB, but do not show symptoms (latent TB). In the United States, between 10 and 15 million people are infected with latent TB. In other parts of the world, like in Central Asia, this number is much higher.
I found out that I had latent TB at the exam to get my first medical clearance as a foreign service officer. I suspect that I was exposed to TB while I was a volunteer in Indonesia years before. Although I was shocked and worried when I got the diagnosis, the nurse reassured me and explained that latent TB is widespread in many developing countries and that there are options for treatment. I was pregnant then so isoniazid treatment—what I’m taking now—was not an option.
I learned soon after I was diagnosed with latent TB that anyone—grandparents, fathers, mothers, and children—can be exposed and infected. In the three minutes that it will take you to read this blog post, nine people will have died from TB. Although my chance of becoming sick with active TB in my lifetime is only 1 in 10, I felt that it was important to mitigate this risk and undergo the six-month treatment regimen. Every year, approximately 2 million people die from TB.
Compared with the experience of a typical TB patient in Central Asia, the past four months have been incredibly easy for me. In Kazakhstan, for example, a patient with active TB is required to be hospitalized in a TB treatment facility for a minimum of two months even if she is no longer contagious after a short period of treatment. She is not allowed to go to work or see her family and often faces tremendous stigma and discrimination if people find out she has TB. Moreover, poor infection control practices in TB facilities greatly increase the risk that patients will be exposed to and contract either drug-sensitive TB or, worse, multi-drug resistant TB (MDR TB). MDR-TB is a form of TB that does not respond to standard first-line TB treatment, making the treatment longer, more costly, and more likely to result in serious adverse effects. Since TB is contagious and someone with active TB can infect an average of 10 to 15 people a year, infection control is critical to protect both patients and health care providers.
MDR-TB can also caused by failure to complete the standard course of TB treatment. If I were a TB patient in Central Asia, after months in a TB hospital, I would be required to visit a health facility every day for at least seven months to take TB drugs as part of directly observed therapy. The health facility is sometimes located far away from the patient’s home. Given these challenges, it is no wonder that patient adherence rates to treatment can be as low as 25 percent in some places in Central Asia.
On World TB Day, I am heartened by the work that USAID has been doing in Central Asia to reduce the spread of this terrible disease. Across the region, we are working with governments, the Global Fund to Fight AIDS, TB, and Malaria, and other international partners to focus our efforts in three areas. First, we are reducing the time that patients are required to stay in TB facilities by improving outpatient TB treatment in order to prevent hospital-based transmission of MDR TB and increase treatment adherence. We also are introducing new diagnostic technologies that can diagnose MDR TB within a few hours as opposed to a few weeks, which will expedite their care plan , as well as to help reduce the time that undiagnosed MDR TB patients are potentially exposing others, both in the community and in health care facilities. Finally, we are supporting an intensive program to build the skills of health providers, communities, and patients to understand and address the treatment and care of people with TB and MDR TB.
A few months ago, I had the privilege of meeting Zamira,* a 23-year old MDR TB patient who was successfully treated and cured as a result of USAID’s assistance. She told me of her anger and despair when she was first diagnosed with MDR TB. Her brother, father, and mother had all died of complications from TB, and she was sure that she would die as well. Through continuous support and counseling, Zamira managed to complete the two-year course of treatment. She glowed with excitement when she told me about her plans for her upcoming wedding and for the new life ahead of her.
Today, Zamira’s mission is to help TB patients get treatment, and her message to them is: “My mother and my brother got sick in the days before you could get drugs for free, so they didn’t have a chance. Now that you can get drugs for free, please take them. You should complete your treatment, because if you don’t, you can die from this disease.”
So on World TB Day, when I reach for my bottle of isoniazid, I will be thinking of Zamira with the hope that we will be able to stop the spread of TB in Central Asia.
*Zamira is not her real name. Her name was changed to protect her privacy.