Tackling Multidrug-Resistant TB in Lesotho — a photo story

Story by: Unitaid

Image: Graeme Williams/Unitaid
Limpho Taka, a 47-year old patient with HIV and multidrug-resistant TB, (MDR-TB) lives in Mpokochela, a village in the Drakenberg mountains of Lesotho. It takes him three hours on his horse to reach the Bobete clinic where he receives treatment for MDR-TB. His family has a little farm with three horses, 73 sheep, eight cows and seven chickens. He grows sorghum, wheat and vegetables for a living.
He fell ill with TB several times, was cured, and then went to work in a goldmine in South Africa to earn more money as he did not want to sell his animals. He earned 1500 rand per month (US $115) and worked inside the mine as a machine operative, drilling for gold.
On his return to Lesotho he got sick and was diagnosed with MDR-TB. He started treatment, but failed the standard treatment regimen for the disease because of its harrowing side effects. He was bed-ridden for one year, which caused severe bed sores and oedema. Today he is feeling much better thanks to the new MDR-TB drugs he is taking as part of the endTB project funded by Unitaid.
Image: Graeme Williams/Unitaid
Limpho Taka receives medication from his treatment supporter, Maliensoane Khafo, at the Bobete health clinic in Thaba-Tseka district.
Image: Graeme Williams/Unitaid

In 2015, an estimated 580,000 new cases of people resistant to first-line TB drugs were detected. Existing treatments for MDR-TB are long, toxic, with often severe side effects, such as acute psychosis and deafness. Only half of those on treatment are cured.

Unitaid launched a US$ 60 million project in 2015 to increase access to better, shorter treatments for MDR-TB. The four-year endTB project to expand new drug markets for TB is being implemented by Partners in Health, Médecins Sans Frontières, and Interactive Research & Development. It will enroll 2,600 MDR-TB patients on treatment with two new drugs — bedaquiline and delamanid — that are the first to be developed in almost half a century.
The aim of the observational trial is to speed up access to new drugs while demonstrating that they can be used effectively in resource-limited settings. The objective of the clinical trial is to develop shorter, simpler, less toxic regimens.
Image: Graeme Williams/Unitaid
Lesotho has among the highest TB incidence and HIV prevalence rates in the world with 17,000 new TB cases annually, of which slightly less than half are notified. Nearly three quarters of TB patients are co-infected with HIV. Lesotho’s mountainous terrain makes it difficult to treat patients in rural villages.
Image: Graeme Williams/Unitaid
Lesotho’s MDR-TB rates are higher than many other African countries. 
This is mainly due to high transmission of the disease in South African mines where thousands of men from Lesotho work to earn their living. The miners often return home, contributing to the spread of MDR-TB.
Image: Graeme Williams/Unitaid
The Ministry of Health has outsourced MDR-TB management to Partners in Health (PIH), a US-based health care non-profit organization. PIH has seven primary health care clinics across the country and manages Botshabelo MDR-TB Hospital, the only one in the country.
Image: Graeme Williams/Unitaid
Lesotho is one of 15 countries included in the Unitaid-funded endTB observational study and one of six countries planning to also implement the endTB clinical trial.
Image: Graeme Williams/Unitaid
The introduction of bedaquiline and delamanid has been very successful as they are less toxic than other MDR-TB drugs.
Image: Graeme Williams/Unitaid
Patients are relieved to switch to the two new drugs because it enables them to avoid painful injectable drugs that can have severe side effects.
Image: Graeme Williams/Unitaid
Highly resistant TB strains are no longer a death sentence in Lesotho as new medicines improve cure rates. It is estimated that the MDR-TB mortality rate has fallen since the introduction of the new drugs.
Image: Graeme Williams/Unitaid
Lesotho’s Health Minister, Dr Molotsi Monyamane, said that TB, HIV/AIDS and maternal and child health are the top health priorities in Lesotho. Universal health coverage is also a priority, but the landlocked country’s geography and limited human and financial resources pose a significant challenge.
Image: Graeme Williams/Unitaid
Tsebo Nuebe, a lab technician, conducts a test to detect MDR-TB with the GeneXpert machine, a rapid TB test.
Image: Graeme Williams/Unitaid
PIH manages Lesotho’s service delivery for MDR-TB, with well-trained staff, quality-assured laboratory and medicines, availability of ancillary drugs to manage side-effects and a strong system of treatment supporters (community health workers) responsible for individual patient care. There is also social support for patients (including housing) and each month the patients receive a basic food-package sufficient to cover the needs for a family.
Image: Graeme Williams/Unitaid
PIH’s temporary accommodation houses MDR-TB patients who do not qualify for hospital accommodation, and have problems staying at home due to distance or lack of care. Recovering MDR-TB patient Marethabile Tjeketsi (right) with her treatment supporter (left).
Image: Graeme Williams/Unitaid
Two young men in traditional blankets riding horses, the traditional mode of transport in Lesotho’s mountainous terrain.