November 8, 2016 | ,

A picture of vitality: reversing the tuberculosis trend

A teenage boy’s agonizing illness is finally identified at school, thanks to an integrated project in Kenya.
A woman and four men stand in front of a brick wall.
Blaiz Atambo (second from right) was diagnosed with tuberculosis through an APHIAplus Western–supported school screening program. Blaiz stands with his care team outside of his home (left to right): Jane Angwenyi and James Jammony, community health volunteers; Fred Ombati, tuberculosis coordinator at Kijauri Sub-District Hospital; and his father Joseph Kabaka. Photo: PATH/Celina Kareiva.

Editor’s note: A wide-reaching project in Western Kenya is having a profound effect on the lives of children and adults by tackling a complicated web of health issues. Meet some of the individuals benefiting from the PATH-led APHIAplus Western, short for AIDS, Population, and Health Integrated Assistance, which is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

Outside of Menyenya Primary School in rural Kisii, schoolchildren dressed in maroon uniforms dart across the playfield, chasing loose tires and one another in a frenzied game of tag. In the middle of this animated scene stands 14-year-old Blaiz Atambo, who just one year ago, would not have been among his classmates.

Last March, after six agonizing months of poor health, Blaiz was diagnosed with tuberculosis (TB). At first his father thought his son had malaria. Like TB, malaria is a leading cause of severe illness and death in Western Kenya.

“I was so worried,” recounts Blaiz’s father, Joseph Kabaka. “Before we knew he had TB, during that six months of suffering, even his performance in school was going down.”

The “good fortune” of a positive test

Blaiz was finally found to be smear-positive for TB when a team of health providers from Kijauri Sub-District Hospital visited his school for a routine screening—one of 69 schools in Kisii and Nyamira counties reached through a PATH-led APHIAplus Western intervention which is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

“He had so many questions initially—‘What is going to happen to me? What is going to happen to my parents? What is going to happen to my education?’” remembers Fred Ombati, TB coordinator at the hospital.

A teenage boy talks to an older man in front of a brick wall.
Blaiz (R) had many questions after he was diagnosed with tuberculosis. As part of the APHIAplus Western services, Fred Ombati (to the left of Blaiz) was there to answer the boy’s concerns. Photo: PATH/Celina Kareiva.

TB exacts its most devastating toll on the productive years, among youth and adults between the ages of 15 and 44. School testing among symptomatic students provides an opportunity to identify cases before they progress to infectious TB during adolescence and adulthood, explains Fred.

Together, in the same room

Blaiz sits in the cool shade of his living room, surrounded by a small team of health providers—James Jammony, local community health volunteer (CHV); Jane Angwenyi, CHV; Anne Abonyo, community prevention technical officer for PATH and the APHIAplus Western project; Fred, who first diagnosed Blaiz; and Blaiz’s father. Sitting shoulder to shoulder, they embody integrated programming—strong community-facility linkages with providers, patients, and support systems in the same room together.

APHIAplus Western, or AIDS, Population, and Health Integrated Assistance Zone 1, is a wide-reaching project tackling a complicated web of health issues, including family planning, maternal and child health, HIV/AIDS, TB, malaria, and nutrition services, for which PATH is responsible in ten counties in Western Kenya. The project integrates community care both within and beyond the health sectors. APHIAplus Western also addresses factors affecting health, such as poverty, sociocultural norms, education, water supplies, and sanitation.

In the first quarter of 2015, the project reached 2,476 individuals with information about TB and screened 352 pupils, 15 of whom were referred for further investigation.

A brightly colored bar graph is titled "Percent of diagnosed who receive treatment."
This graph shows that the percentage of tuberculosis patients who completed treatment in each gender and age group increased from 2014 to 2015. Young girls saw the highest increase in treatment completion, jumping from 55% up to 69%. APHIAplus Western data compiled by Emily Beylerian. Graphs: PATH/Sara McSorley.

Together in treatment

Last March, Blaiz was started on a drug treatment regimen of rifampicin, isoniazid, pyrazinamide, and ethambutol for two months, before receiving four months of exclusively rifampicin and isoniazid. Shortly after diagnosis, his village’s CHV, Jane, screened other members of his household who, simply by proximity to Blaiz, were at heightened risk. These community screening tools also allow for prompt tracking of the disease.

For a time, TB programming was contained to the health sector. CHVs were predominantly responsible for patient referrals.

“After referring them to the facility, it used to end there,” says Fred. “We came to realize that referring a patient to a facility is not the end of it. The client lives in the community. . . so that is where we must do much of our work.”

Education beyond the school walls

Group of male children sitting on grass and studying. Books spread out in front of them.
Through the APHIAplus Western project, services and community involvement help to ensure that growing children can focus on what’s most important; going to school and simply being a child. Photo: PATH/Gabe Bienczycki.

Blaiz is a shy boy, who averts his eyes when addressed. Though his grades declined when his health began to deteriorate, he has always been a good student, his father says.

“You see he is a young boy who maybe . . . could concentrate on his studies and forget the medicine,” adds Fred.

To ensure adherence, Jane visited Blaiz twice a week while he was on treatment. His health care team also worked with his teachers and primary school to ensure he received a small snack between his morning classes and lunch. The drugs used to treat TB can increase appetite, making it harder for patients to concentrate on day-to-day tasks and schoolwork.

Fred delivered prevention messaging to Blaiz’s classmates and family. Often, simple interventions such as creating well-ventilated spaces for TB infectious patients, are not realistic for the modest homes and structures of Kisii’s countryside. But Fred shared messaging on cough etiquette—how to cough into the collar of a jacket or sweater instead of their hands. Fred also taught Blaiz to keep a small container for sputum, so he wouldn’t have to disrupt class for the cough attacks that often seize TB patients. And Fred debunked many of the myths and misconceptions surrounding TB. Because of the high rates of TB–HIV coinfection in Kenya, it is assumed that any TB-positive individual is also HIV positive.

Between March of 2013 and December of 2015, the number of TB cases in care increased from 90,479 to 113,520. A significant proportion of those cases were also being tested for HIV. In the last quarter of 2015, 81 percent of TB cases had been dually screened for HIV.

The proactive outreach of Blaiz’s health care staff—responding to the worries and questions that usually accompany diagnosis, inquiring about patient progress, and ensuring that patients return to their medicine regimens if they’ve forgotten—allowed Blaiz to maintain some semblance of normalcy throughout his recovery. Even in the face of new drugs and treatment options, these moments of connection are what can lead to success.

“I did my schooling as I continued treatment,” says Blaiz shyly. “It never interrupted school.”

Today he is TB free. Blaiz at one point weighed just 72 pounds. Though he is still skinny for his age, he has put on weight. His grades are also on an uptick. “He is improving month after month,” says his father.

In fact, motivated in part by his care team, Blaiz hopes to be a doctor one day.

The AIDS, Population and Health Integrated Assistance (APHIAplus) program is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID).

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  • Celina Kareiva is a project coordinator on both the Menstrual Health and Applied Behavioral Communication work teams at PATH.
  • Emily Beylerian is a data analyst and an associate in the Results Management, Measurement, and Learning department at PATH.