Local doctors are worried that Botswana may be on the verge of a drug resistant TB epidemic because the Ministry of Health blundered into introducing (Isoniazid) INH prophylaxis treatment in the local health system before putting it through a randomized study.
In a bid to stem the rise of TB co-infection with HIV-AIDS, all patients at government hospitals who test positive to HIV/AIDS are put on a six-month course of INH prophylaxis treatment before being given antiretrovirals.
Isoniazid, which is commonly referred to as INH, is an important first line TB drug. Sunday Standard investigations have turned up information that the Ministry of Health introduced the INH prophylaxis treatment in the Botswana health system in haste before putting it through a randomized study and the results are showing that high levels of resistance are being encountered clinically.
Investigations have further revealed that since Botswana does not have an infectious diseases hospital, most patients with a resistant strain of TB are kept in the medical ward while others are left to go back home. Anyone who is infected by a person with a drug resistant TB will also develop a strain of TB that is resistant to treatment. There are fears among local doctors that some patients are being infected in their hospital wards while some members of the public may be infected with the drug resistant strain by patients who are allowed to go home.
“It is terrible. We are sitting on a very explosive situation. Botswana is facing a drug resistant TB epidemic.”
The problem is further complicated by the fact that, at the moment, the pharmaceutical industry has no new TB drugs in the pipeline, and Botswana may find itself with a drug resistant TB epidemic with no option for treatment.
The medical fraternity is divided on whether the failure of the INH prophylaxis treatment is due to the rapid progression to disease or insufficient duration of INH in subjects with relatively advanced immunosuppression.
While the Ministry of Health is considering extending the INH prophylaxis treatment from six months to 12 months before introducing HIV patients to ARVs, most doctors feel that patients who test positive to HIV should immediately be introduced to ARVs to build immunity before they are put on INH prophylaxis treatment.
In an interview with The Sunday Standard, Health Minister Dr Sheila Tlou said there is a clinicians meeting coming up and doctors will be consulted on the issue.
“These are the people who deal directly with patients and have first hand experience of the situation on the ground, so we never do anything without consulting them.”
Dr Tlou said no decision has been taken yet to extend the INH prophylaxis treatment from six to 12 months.
“We are still working on HIV treatment; guidelines are some of the things we will be looking at and we will determine the extent of viral load at which patients may be introduced to INH or ARV but these are not the things I can discuss with you, besides, comments and opinions of our clinicians will be taken into consideration when drawing up the guidelines.”
Dr Tlou, however, would not comment on why the INH prophylaxis treatment was introduced before being put through a randomized study.