This was disclosed at the Okuryangava Clinic in Katutura, where United States Ambassador to Namibia, Thomas Daughton, was conducting a site visit to the Tuberculosis-Directly Observed Treatment (TB-DOT) container, which was donated by the American Government three years ago.
The Okuryangava Clinic has the second largest burden of TB-HIV cases in the country with over 1,000 out of the Khomas region’s 3,500 TB patients being treated at the facility.
This prompted the US Government, through the President’s Emergency Plan for AIDS Relief (PEPFAR) initiative and USAID to run a TB/HIV programme at the clinic, called Challenge TB.
Namibia is the fourth worst TB affected country in the world, with 9,882 patients diagnosed with the disease in 2014.
“It is crucial to continue to provide comprehensive tuberculosis and HIV services in Namibia, because for reasons we don’t really fully understand yet, Namibia has one of the highest HIV/TB co-infection rates in the world, meaning that on average, about 4 out of every 10 patients with tuberculosis are also HIV-positive,” Daughton said, during this week’s onsite visit to Okuryangava Clinic.
The estimated cost of treating one patient with TB (usual form) is less than N$1,000, while it is estimated that the cost of treating one patient with drug-resistant TB averages more than N$51,000.
During a psychotic episode, an individual may experience hallucinations and/or delusions. This can be incredibly frightening for the individual and, sometimes, the symptoms can cause them to lash out and hurt themselves or others.
Dr Mubele Kalonji, who is in charge of Okuryangava Clinic, said that patients sometimes find it difficult to complete treatment, and stop midway, thereby opening themselves up to a drug-resistant strain of the disease.
He said that in some instances, this was due to the severity of the treatment.
“We have what we call susceptible TB, which is the normal one and which responds well to the treatment, and the person is on treatment for six months. Then we have the second one, where a person gets TB for the second time, which is called relapse TB, and those ones have different treatment, and on top of the tablets, we add an injection and the person is on treatment for eight months.
“The third category is what we call drug-resistant TB, and those ones do not respond to the previous treatment at all, so we have to look for a different regiment all together, and the duration of intake is a minimum of two years. So depending on how they are doing with treatment, they can even go beyond two years of treatment,” Kalonji said.
He said it is not always easy for patients to complete their treatment, especially those in the third category, where they are given an injection six days a week for a minimum of six months.
“In the third category there are some medications which have side-effects, causing psychiatric problems, so those have a tendency to commit suicide, which is why before even starting the treatment, the patient is offered counselling,” he said.
Kalonji added that they first look at the degree of the side-effects, before deciding to stop treatment or to adjust the dosage accordingly.
According to the National Study on the Prevalence of and Interventions in Relation to Suicide in Namibia draft report, a shocking 25,000 Namibians attempted to commit suicide in 2015, while 467 succeeded in ending their lives, placing the country third in Africa, behind Mozambique and Burundi, and 12th globally, in terms of the rate at which citizens are killing themselves.
However, the link between TB-HIV and suicide has never been critically examined.
Ministry of Health and Social Services Permanent Secretary, Andreas Mwoombola, said that the ministry is in the process of finalising the construction of a TB hospital in Keetmanshoop, as well the establishment of a TB isolation division in the North.
“We are busy with arrangements so that those who are resistant to TB medication can be either given attention, so people do not go around infecting others,” he said.
Namibia has grappled with drug-resistant TB since 2014, with such patients being reported in all regions.
While, the TB burden in the country remains high, there has been a progressive decline in case numbers since 2006.
Meanwhile, the combination of HIV and TB remains a key challenge as, about 41 percent out of the 94 percent of TB patients tested positive for HIV in 2015.
According to Daughton, treating someone who has contracted both HIV and tuberculosis is far more difficult, as the two together can become too strong for the patient to fight.