Doctors Without Borders/Médecins Sans Frontières (MSF) is working with medical facilities in western Somaliland and Somalia's Puntland state to improve care for patients with drug-resistant tuberculosis (DR-TB), through diagnosis and treatment with an updated, shorter oral treatment regimen.
"Tuberculosis is a longstanding health concern in this region," said Jocelyne Madrilene, head of MSF's tuberculosis program in Somaliland. "We are focusing specifically on improving care for people with drug-resistant tuberculosis because it is more complicated for the patient and the medical system to manage."
Somaliland faces a relatively high burden of tuberculosis, which spreads more easily when health and living conditions make people more vulnerable. People fleeing recurrent conflicts and droughts in the region often live in close quarters, increasing the risk of tuberculosis transmission within a household.
Drug-resistant forms of tuberculosis are more difficult to treat and threaten progress in the fight against tuberculosis. According to a 2019 World Health Organization estimate, Somalia and Somaliland have 26 new cases of multidrug-resistant tuberculosis per 100,000 people per year, which is among the highest rates in Africa.
MSF started supporting the Somaliland MoHD in the diagnosis and treatment of DR-TB in 2019. Today, MSF is providing medical and technical support at a tuberculosis hospital in Hargeisa and three regional tuberculosis centers in Borama, Berbera, and Burco. So far, 96 patients with DR-TB have received treatment through this initiative, 39 of whom have completed their treatment.
Learning about DR-TB
Sadiq Ibrahim Mohamed, 20, is one of the first patients in Hargeisa on the shorter DR-TB treatment regimen, and he spoke about his experiences to encourage others to seek testing and treatment.
"I suspected myself after I developed a persistent cough, fatigue, and high fever especially at night," Mohamed said. "My worry at the time was the fear of something more dangerous than TB. After the tests, doctors informed me it was DR-TB, they tested both my blood and sputum to confirm it. They explained that I needed the new oral DR-TB medication (bedaquiline) ... I got more relaxed and accepted my condition after I was told of how DR-TB is treatable."
MSF is now focusing on outreach to sites where nearly 100,000 displaced people live in Hargeisa, to encourage people to be tested for tuberculosis. Anyone with tuberculosis, including DR-TB, can then enroll in treatment.
"What is important for everyone to know is that tuberculosis can be cured, including drug-resistant tuberculosis," Madrilene said. "People with symptoms of tuberculosis should seek testing from a health center because treatment can save lives."
In 2020, MSF and Somaliland's Ministry of Health and Development began enrolling eligible DR-TB patients in an updated treatment regimen that is easier for patients to complete. It involves taking oral DR-TB medications for nine months, rather than for 20 months, which had been the standard course of treatment. The new regimen includes bedaquiline, which is one of only three tuberculosis medications to be developed in more than half a century.
In Galkayo North, MSF supports a tuberculosis hospital that serves people in Somalia's Puntland state and Mudug region. Since 2018, MSF has helped treat 51 patients with a nine-month oral treatment regimen for DR-TB, including bedaquiline. A total of 37 patients have completed their treatment while 14 are still on treatment.
The transition from injectable to oral medication enables DR-TB patients to continue their treatment at home rather than return daily to a health facility for an injection, as was the case before. Patients self-administer their oral medications at home with the help of a family member who has received training. Patients also require less frequent visits to health facilities, because the oral regimen produces fewer side effects that require monitoring.
MSF provides social support packages for tuberculosis patients including food, counseling, and psychosocial support.