Tuberculosis (TB) is an airborne disease that can spread easily in a home environment, putting patients’ families at risk of catching TB themselves. MSF medical coordinator in Sierra Leone, Dr. Bukola Oluyide, explains how a new preventive treatment called tuberculosis preventive therapy can safeguard the lives of patients’ families and other people at high risk.
What is tuberculosis preventive therapy?
“This new preventive treatment aims to prevent active TB disease in individuals who have no visible symptoms of TB infection or are at a high risk of developing the disease. It includes at least one anti-TB medicine. When given to people who are infected with the TB bacteria or have been exposed to it, it prevents the development of the TB disease.”
What is the significance of this treatment in Sierra Leone?
“In 2016, Sierra Leone was included on the list of 30 high burden countries for TB by the World Health Organization (WHO), and it is still on this list. People infected with the TB bacteria have a 5-10 per cent lifetime risk of falling ill with TB, so it is important to avoid this risk by implementing TB preventive therapy for those who have no visible symptoms, but who are exposed to the bacteria from a family member or have other risk factors for developing the disease, including living with HIV, being under the age of five and having a weakened immune system.”
How does the new treatment benefit children?
“Children who are exposed to TB are at a higher risk of developing severe and potentially fatal forms of the disease, such as TB meningitis. In communities with high TB prevalence, TB preventive therapy substantially reduces the risk of TB among under-fives and children living with HIV.”
How is MSF implementing the treatment?
“People with symptoms that suggest TB are tested with rapid molecular tests. Those found positive are started on treatment. Those who test negative are assessed for TB preventive therapy if they are considered to be high-risk – for example if they are living with HIV or in contact with patients who have TB.
TB is still highly stigmatised in Sierra Leone, so it is vital to take a sensitive approach. During a home visit to a diagnosed TB patient, we discuss with family members how important their support is for the patient, the need for them to be screened for TB, and the desirability of starting TB preventive therapy as a protective measure, even if their test results show that they do not have TB.
The regimen in TB preventive therapy is determined by the person’s age, HIV status and whether or not they are pregnant. We also take into account any HIV or other medications they are taking to avoid negative drug interactions.
Before starting treatment, the individual is counselled on the importance of adhering to and completing the treatment. This is especially important for those who may not feel the need to take the medication since they are not showing symptoms. We emphasize the importance of TB preventive therapy, the duration of the treatment, any potential side effects and how to recognise symptoms of TB.
After starting treatment, we do a follow-up consultation to monitor people’s adherence, ensure they can access refills of medications, and check for the development of TB symptoms.”
Is MSF working alone or alongside national health authorities?
“We are working in collaboration with Sierra Leone’s National Leprosy and Tuberculosis Control Program (NLTCP). First, we discussed the steps for implementation; next we made sure that the medication would be available in-country, sponsored by the Global Fund to Fight AIDS, Tuberculosis, and Malaria; next we discussed how the drugs would be distributed. MSF also trained Ministry of Health staff at 15 MSF-supported directly observed therapy (DOT) sites in Bombali district in screening individuals on their eligibility to be started on TB preventive therapy, dispensing medication and counselling individuals.
Now that the programme is up and running, the NLTCP ensures the availability of the medications and data collection at the DOT sites, while we follow up on implementing the preventive treatment, addressing challenges and providing support to make the delivery of the services as smooth as possible.”
What do you hope to achieve by implementing TB preventive therapy?
“Reducing the TB burden in Sierra Leone is our primary objective. By working collaboratively with the Ministry of Health and training its staff, we are also ensuring that the delivery of care is suitable and that services can continue in Bombali district and elsewhere even without MSF’s support.”
What has been the impact so far?
“MSF and MoH started providing TB preventive therapy in Bombali district in March 2024. In the year since then, we have initiated 317 people on treatment: 35 were children under five, 76 were aged from five to 14, and the remaining 206 were 15 years or older. It is too early to evaluate the impact of the treatment, but we encourage the NLTCP to plan an evaluation of the impact in the coming years.”
What challenges have you encountered over the past year?
“It can be difficult to get people to start treatment when they do not feel sick or show any symptoms. Parents who are TB patients themselves are often convinced that they can protect their children from catching the disease without any outside help. This is why counselling is very important to ensure that individuals understand and accept the reasons for starting treatment.
Since we began to implement the project, we have also realised the need to cover people’s transport costs to get drug refills, the importance of community-based models, and the need for children-friendly formulations of the treatment.”
MSF is working with the Ministry of Health’s National Leprosy and Tuberculosis Control Program (NLTCP) in Bombali district, Sierra Leone, to improve access, diagnosis, treatment and prevention of TB in both adults and children, including drug-resistant forms of the disease. MSF supports 15 directly observed therapy (DOT) sites in primary healthcare facilities across Bombali district as well as the drug-resistant TB ward at Makeni regional hospital.
ENDS