At least a third of people in Botswana have HIV. Numbers of those dying from the disease has been going down steadily since government introduced AIDS medicines in 2003.
However a constant threat to government's efforts remains the co-existence of tuberculosis TB and HIV, as it is very difficult to treat people infected with both.
Normally a person diagnosed with HIV, but not yet sick to qualify for ARV treatment is placed on TB treatment to prevent latent TB - to help strengthen their immunity to the TB antigen. In line with World Health Organisation and Botswana government standard people found to be HIV positive are put on Isoniazid Preventive Therapy (TB treatment) for six months. Failure to complete the treatment may result in a strain of TB that is more difficult to treat, called Multi Drug Resistant TB (MDR-TB). This, according to the Ministry of health, has become the latest challenge to government's overall health initiatives. This is because MDR-TB, is resistant to isoniazid and refampicin, two drugs used in the treatment of TB.
"MDR-TB is a big challenge because TB is contagious. While there are alternative drugs, they are too expensive and there can be adverse effects such as deafness," said Dr. Joconiah Chirenda, public health specialist with the Ministry.
Dr. Chirenda indicated that in 2008, the Botswana National Tuberculosis Control Program (BNTP) conducted a national drug resistance surveillance study, which showed that the prevalence of MDR TB is about 3.5% in new TB cases and 13.6% amongst repeat cases.
He said that the main reason for the MDR-TB occurrence is poor TB treatment compliance by patients.
"It is important that people take the full course of the TB treatment to avoid developing resistance to the first line of TB treatment and thus MDR-TB," he said.
Dr. Chirenda said that timely diagnosis of patients was difficult as the capacity of laboratories at both district and national level was inadequate to deal with the many specimen that they receive at any given time. High patient mobility also makes recording and monitoring of treatment intake by health personnel difficult.
