#ZambiaHealth – The challenge of HIV and TB co-infection

HIV and TB co-infection is now a major area of concern in countries like Zambia. People living with HIV, who have impaired immune systems, are particularly vulnerable to the lung disease TB. One of the current challenges is to find ways to prevent both.

As part of our #ZambiaHealth trip we visited N’gombe Integrated HIV/TB Clinic in one of Lusaka’s compounds, or what may be called a slum in other countries.

About 5,000 people live in the compound but the clinic covers a catchment area of 49,000 people, who attend for a range of reasons. When we arrived the area outside the clinic was packed with mothers carrying their babies who were going to be immunised, men waiting to be circumcised, women queuing up for cervical cancer screening and patients with HIV collecting their ARV drugs.

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Baby Ethel takes a nap as she waits for her immunisations

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Six-year-old Mercy waits to see the doctor about her cough

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Esther, 13, looks after her two-month-old sister Princess

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Mirriam and her 17-month-old daughter Elisha wait to see a nurse

On every visit patients are asked whether they know their HIV status and, if not, whether they would like to take a test. Although it is not compulsory those who do know there status are able to move through the process of seeing a doctor faster.

Some years ago directors at the clinic decided to integrate its previously separate outpatient and ARV departments in order to allow patients to collect their drugs without the stigma which is sometimes associated with it. About 6,000 of the clinic’s patients have HIV but they are now able to wait along with everyone else outside the outpatients department so no one else knows which service they are accessing.

However the clinic’s TB unit remains separate in order to reduce the spread of the contagious disease which is passed on through the air as people cough, sneeze, talk or spit. Many of the clinic’s TB patients are co-infected with HIV and there is a TB/HIV co-infected support group which meets once a month.

Those patients arriving at the TB clinic must take an HIV test. They must then begin a six month course of treatment. This number increases to eight months, including two months of daily injections, for patients who have the disease for a second time.

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A nurse explains TB treatment to patients

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TB medication

We experienced the effects TB can have on a patient’s life when we visited the home of Godfrey Chileshi. He was first diagnosed with TB in 1998 but recently discovered that he has the disease for a second time and has begun another course of treatment.

The 58-year-old said: “The first time it took a while for me to notice it. I only went to the hospital after I had been feeling unwell for some time. But the next time, after a week or two, I was expecting what it would be as I had it before.”

Symptoms of TB include a persistent cough, aches in the body, high temperatures and night sweats. Mr Chileshi will now have to take treatment for eight months, including the daily injections. He has been unable to continue in his job as a security man.

He said: “I just don’t feel as I used to feel. I am not able to work and my body is not feeling good. I have aches and pains in my legs and hands.”

Mr Chileshi lives with his wife, who has not been tested for TB, and three of their six children. They receive no state assistance and the only money they make is from selling produce they have grown from a small table outside their house. The couple said finding the money for food is a constant worry for them.

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The Chileshis and two of their grandchildren

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The small amount of produce the couple are able to sell

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