…TB at age 5, meningitis, and repeat TB in 2003, HIV in 2004, and COVID-19 in 2021

CATHERINE MUROMBEDZI
HEALTH CORRESPONDENT

Her first name is Chishamiso. It means a miracle.
A lived experience, having survived tuberculosis at the age of five in 1970 is no mean feat. Surving meningitis spaning from 2003 to 2009 on treatment, coupled with a second bout of TB in 2003, her testimony is a mirror of family love and support.
In July 2021, she could hardly walk, she crawled as she battled COVID-19.

An HIV positive diagnosis in 2004, coupled with the arduous stretching meningitis treatment, resilience has seen Chishamiso Brantina Zhanje, who was born in 1965 in Domboshava, giving back to society. She is a volunteer at Budiriro Poly Clinic, in Harare today.
Zhanje is an active member of the Zimbabwe National Network of TB Survivors. The network is barely a year old. It is a safe place where TB survivors share health tips, business ideas, and work as volunteers where their services are needed.
Zhanje is also a long-time voluntary worker at Parirenyatwa Annex Hospital.
She is a counselor in the TB survivors network.
“All I remember is that we would take a lot of pills every morning after taking breakfast. I was five years old then in 1970. My father, my brother, and I had TB at the same time. We were admitted in a TB ward in Makumbe Mission Hospital for six months. Today, I have a scar on my left hand. This was a six pin imprint to show successful completion of TB treatment at Makumbe Mission Hospital,” said Zhanje.
Back then, Makumbe Mission Hospital was a sanatorium where TB patients were admitted for treatment. The TB response has made dynamic strides, and today, TB patients are treated coming from their homes.
Zhanje never faced discrimination from her relatives and family.

“I recall that I was well taken care of as a five-year-old girl. Everyone loved and treated me very well. My mother was particular about what the family ate. She prepared a balanced diet,” she said.
Zhanje started school at the age of seven, like all her mates, then.
“The Makumbe Mission Hospital was well known for treating TB successfully. Many people flocked to the health oasis. So for our community, TB did not carry any label nor stigma,” said Zhanje.

“In 2003, I had a second and severe bout of TB.
I was then aged 38. The treatment was long. I had injections every day for a year. In 2004, I tested positive for HIV. I guess the loss of immunity could have been earlier to have an opportunistic infection of TB in 2003,” she pointed out.
“I am 59 years old now. It is God’s grace to be alive. I have lived with HIV since 2004. I am on second line treatment. I was on combivor and niverapine at Budiriro Poly Clinic. I got infected with meningitis. For five years, I was on fluconazole treatment from 2004 to 2009. God is my helper, I recovered,” said Zhanje.
Zhanje later experienced treatment failure to anti HIV medication.
“I never missed any doses. I am alert to my health challenges, so I adhere to treatment as prescribed. In 2014, I started to lose weight. My viral load was very high over a million copies. My CD4 Count was very low, too, around 200ml copies. I was recounselled and educated that I was now going to be on second line treatment,” she said.
Today, Zhanje is doing very well on second line anti HIV treatment.
When someone fails first-line antiretroviral therapy (ART), it means the virus has developed resistance to the medications. The virus has mutated and is clever to render the treatment ineffective. The treatment is no longer effective in suppressing the HIV virus. It is termed antiviral resistance (AVR). The virus is now able to resist the effects of antiviral medications.
“On 15 July 2021, I was diagnosed with COVID-19. I was given treatment and went home. I was bedridden and confused. I would bump into the wall in my bedroom. In June 2023, I had COVID-19 for the second time. I feel God has a pursuit that I should fulfill,” said Zhanje.
Dr Joseph Tafi educated on drug resistance. He said it is mainly due to poor treatment adherence.
“Drug resistance is mainly due to poor adherence to treatment. It can also be a result of inadequate dosing or failure to maintain a time set to take treatment. The frequency must be maintained to achieve optimum treatment levels of medication required to suppress the virus. Please, take note, that due to a lack of resources, everyone testing HIV positive is started on the same treatment regimen in public facilities. No tests are run to find out if one has a pre-existing drug resistance. So, pre-existing drug resistance can not be ruled out. It is for this reason that we urge people to use protection in sexual encountes. Some people living with HIV don’t use condoms claiming that we both are HIV positive. There is a high risk of cross infections leading to drug resistance,” warned Dr Tafi.
Dr Tafi spoke of transitioning to second-line treatment as a watershed moment.
“The transition is a process. Confirmation of treatment failure is through viral load testing, then review of treatment history and adherence. There is a need for resistance testing (genotypic or phenotypic) to identify mutations. Finally, the selection of a new regimen is based on resistance profile. For those on the free public scheme, the choice is narrow. Usually, it’s one size treatment fitting all. It is necessary to understand this,” he advised.
“The second-line treatment: typically includes a stronger, more efficacious different combination of medications with a change in dosage.
It costs more, around US$300 a year, as compared to the US$80 for first line treatment. There is a potential for more side effects. The treatment options are now few if resistance develops. It is important to adhere to treatment and monitoring is vital,” said Dr Tafi.
Third line treatment is the last resort reserved for patients who have failed second-line treatment, often due to severe resistance.
Zhanje is a member of a TB survivors support group.
“Mukando is a great way to pool resources. Weekly, we give US$5 to a member. When 20 people do so, it is US$100. One is able to start a livelihood project.
“I amplify the effects of treatment failure. We are witnessing high levels of treatment failure by people who use drugs and substances to feel high.
“Failing third-line antiretroviral therapy (ART) indicates extensive HIV resistance, limiting treatment options. There is no fourth line.
“The consequences include opportunistic infections
AIDS progression with poor quality of life. It hastens mortality risk. We have buried many people after treatment failure,” said Zhanje.
The World Health Organisation reports that 37% of TB patients in Zimbabwe also live with HIV.
1.3 million people in Zimbabwe live with HIV (UNAIDS.
13,000 new TB cases reported in Zimbabwe in 2022 (WHO)
CALL TO ACTION
Increase awareness and support for those with multiple health challenges
Reduce stigma surrounding HIV, TB, and other comorbidities
Improve access to integrated healthcare services
The TB survivors network is the brain child of a local organisation working in the national and global TB response, Jointed Hands. The survivors are pivotal in raising awareness and fighting stigma with technical support from the Ministry of Health and Child Care and partners.

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