Kenya rolls out world's second biggest TB prevention project

 At least 400,000 Kenyans living with HIV have been enrolled on a treatment programme to prevent tuberculosis, making this the second-largest programme globally, according to the Ministry of Health.

People living with HIV are up to 21 times more likely to develop TB disease than someone without the virus because of their weakened immune system.

Health Principal Secretary Mary Muthoni said they are thus encouraged to enrol on Isoniazid Prevention Therapy, where they take two pills a week for six months.

TB is the fourth leading cause of death in Kenya, with drug-resistant TB posing a persistent challenge.

“Tuberculosis continues to be a significant public health challenge in Kenya, impacting families and communities with its devastating effects. While primarily affecting the lungs, TB can affect various parts of the body and is transmitted through the air when infected individuals cough,” she said.

Kenya has about 1.2 million people with HIV already on ARV drugs, which means the uptake of TB prevention treatment is still low.

The short-course preventative treatment, consisting of two drugs – rifapentine and isoniazid –was rolled out in Kenya, Mozambique, Ethiopia, Ghana and Zimbabwe, in 2021.

The World Health Organization recommends isoniazid taken for at least six months, and ideally for nine months.

The biggest prevention programme globally is in India.

Muthoni said TB among children is high, with nearly 7,000 cases reported in infants and children in 2015.

“To address this, Kenya is pioneering the use of child-friendly TB medicines, starting October 1, ensuring appropriate doses and flavours suitable for children. This initiative aims to improve treatment adherence, reduce mortality among children and mitigate the risk of drug-resistant TB,” she said.

Kenya on average reports more than 90,000 tuberculosis cases annually, the ministry says.

The ministry also estimates that at least 40,000 people with active TB every year are never diagnosed, never treated and many die without proper treatment.

Last month, the PS said the ministry estimates that in 2022, at least 42,000 Kenyans with active TB were never diagnosed nor treated.

“In 2022, Kenya recorded a staggering 90,841 TB cases, a significant increase from the 77,854 cases reported in 2021,” Muthoni said at the launch of the TB Strategic Plan 2024-28 in Nairobi.

“Alarming as this figure is, it represents only 68 per cent of the estimated 133,000 TB cases that were likely to emerge that year, leaving 32 per cent undiagnosed and untreated.”

When a person develops active TB, the symptoms such as cough, fever, night sweats, weight loss may be mild for months. This can lead to delays in seeking care, and result in transmission of the bacteria to others.

People ill with TB can infect from 10 to 15 others through close contact in one year.

Without proper treatment, up to two thirds of the sick people will die, according to the WHO.

“The emergence of drug-resistant TB cases, totalling 756 in the same period, highlights the urgent need for a comprehensive and coordinated response,” the PS said.

The new strategic plan will be used to raise more money to fight tuberculosis.

“It's important to acknowledge the financial constraints we face, especially with shrinking external funding. The strategic plan, therefore, becomes a vital advocacy tool for resource mobilisation across all sectors, including the private sector,” she said.

Dr Abdourahmane Diallo, the WHO country representative, said Kenya has made progress towards ending TB, even though it is among the seven high TB burden countries globally that exceeded the End TB Strategy milestone for TB incidence and mortality.

“A 38 per cent reduction in TB incidence against a target of 20 per cent, and a 54 per cent reduction in the number of TB deaths against a target of 35 per cent compared to 2015 was reported [in Kenya] in 2022,” he said.

The ministry also launched the Paediatric Algorithm and Short-term Regimen and TB Laboratory Operational plan and Quality management framework.

“The adoption of the simplified diagnostic algorithm will ensure diagnosing TB in children is made easier, contributing to increased, early and more accurate detection,” Diallo said.

Usaid Health, Population and Nutrition director John Kuehnle, said Kenya is well aligned with the global goal of eliminating TB by 2030.

He urged Kenya to embrace new tools and strategies, such as the digital chest x-ray fitted with artificial intelligence for TB screening, and more sensitive point of care WHO recommended rapid molecular diagnostic tests like truenat.

Other tools include the next generation whole genome sequencing for better prevention and treatment, shorter treatment regimen and digital adherence technologies to improve adherence for good treatment outcomes.

“Beyond that, we must also leverage available expertise, and use data to guide our programmes,” he said.

In March last year, a WHO analysis showed Kenya has reduced by 35 per cent of people dying from TB, compared to the deaths recorded in 2015.