Becky Mugisha* had been ill with a hacking cough for three months before she was admitted into one of Kampala’s busiest tuberculosis (TB) wards, but she recognised the symptoms long before that. It was her second bout with the disease.

The last time Mugisha had had TB, about a year before, she was put on a sixth-month course of treatment. As a person living with HIV, she was used to taking multiple pills on a daily basis, but she failed to complete her treatment because the dispensing clinic where she lives in Wakiso, just east of Uganda’s capital, Kampala, ran out of the drugs.

Mugisha’s compromised immune system and treatment history made her susceptible to infection with multi-drug resistant TB (MDR-TB), a strain of the disease that requires more expensive and extensive treatment and affects 4.4 percent of TB patients in Uganda who have previously been treated for the disease, according to the World Health Organisation (WHO). Now Mugisha is receiving inpatient treatment at the TB unit in Mulago Hospital, Kampala's main referral hospital. While many hospitals and health centres outside Kampala can treat TB, few can handle MDR-TB cases that often require long hospital stays.

According to the 2008 Global TB report, released by the WHO this week, Uganda has the unenviable distinction of having the lowest TB cure rate in the world - just 32 percent. The report also notes that in 2004 and 2005, Uganda had the highest default rate [numbers of patients who fail to complete treatment] of all countries with large TB burdens.

While more than half of Uganda’s population may carry a latent form of TB, people with HIV-compromised immune systems are 50 times more likely to develop an active TB infection. TB is the most common opportunistic infection for people living with HIV and accounts for up to half of AIDS-related deaths worldwide.

About half of the patients at Mulago Hospital's TB unit are HIV-positive, said Dr Alphone Okwera, who heads the unit. Many patients don’t know their HIV status before coming to the unit and agreeing to voluntary HIV counselling and testing.
For Mugisha, who already knew her HIV status, her biggest fear when she realised she had TB again, was infecting her husband and two children with whom she shared a one-room home. TB is airborne and highly contagious, especially within cramped, poorly ventilated spaces. It was fear of infecting them that sent her to the hospital.

Mugisha is now too sick to make the beaded necklaces and other crafts that used to help support her family. She told IRIN/PlusNews that her family of four will feel the strain of her absence during her stay at Mulago, but that they would miss her more if she succumbed to TB.

*Not real name

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