It's bad enough to live in a country with the world's highest prevalence of both HIV and tuberculosis (TB). But at least with TB, the treatment is relatively quick — just six months — and effective. Unless of course, you're burdened with drug resistant TB (DR-TB).
Then it's a different story entirely: up to two years of highly toxic chemotherapy drugs, with horrible adverse effects including, in extreme cases, psychosis and deafness. And that's assuming you get diagnosed in time.
Until a few years ago, diagnosis was a big problem in the Kingdom of Swaziland. First you had to access the standard TB test — in itself problematic for the predominately rural population, as the test was only offered in health centres and hospitals, necessitating a lot of travel and expense.
If you did get there and dutifully coughed up your sputum, you then waited up to three months for results while your sample was taken to the National Reference Laboratory for Tuberculosis in the capital city of Mbabne to be cultured.
If the sputum smear was positive and you took the short-course chemotherapy drugs but they didn't work, then another culture would be taken, this time to be sent to a lab in South Africa, to test for drug resistant TB. Another three months.
"Patients could be dead by the time the diagnosis arrived," says Diana Gomez, clinical microbiologist for Médecins sans Frontières (MSF) in Swaziland.
But that was before. Now testing and treatment is available in many clinics, much closer to home for rural Swazis. MSF works in Shiselweni and Manzini, two of the country's four regions. In Shiselweni, TB testing and treatment used to be available in just three locations, but now it's in all 22 clinics, plus a special TB wing has opened at a health centre. In Manzini, separate testing and treatment facilities were constructed at a hospital and three clinics.
In addition, testing is now much faster. Beginning in 2011, MSF set up GeneXpert machines in three Swaziland facilities that detect TB and rifampicin resistance within two hours. The machine also detects 45% more cases and provides a personalized prescription.
A recent assessment of GeneXpert at 25 sites in 18 countries shows an overall 50% increase in diagnosis of TB compared to the sputum smear microscopy.
Gomez says: "It has revolutionized detection."
Swaziland's TB incidence rate is 1275 cases per 100 000 people. That means there are nearly 15 000 people with TB. Neighbouring South Africa has 980 cases per 100 000 and Mozambique has 750.
"The high prevalence is because of high HIV," says Dr. Kazi Arif Uddin, the physician in charge of DR-TB at the Matsapha MSF health clinic in the Manzini region.