Manipur: Providing patient-centered HIV, TB, and hepatitis care to patients

©Jan-Joseph Stok

When Thongsei Lupho, 44, first started feeling unwell, he suspected he had contracted Tuberculosis. He visited MSF’s clinic in Moreh, on the Indo-Myanmar border, where he was diagnosed with HIV. Lupho had used drugs in the past to gain social acceptance in an area where tribal tensions had fostered a lack of trust amongst people. Having put his drug use behind him once he married, his diagnosis came as a shock.

At first, he was afraid of discrimination and felt unable to mingle with others in public. He was also worried about his children, some of whom were also diagnosed with HIV. 

Thongsei Lupho (44) and his wife Mary and some of their seven children. His son sitting next to him is also HIV-positive and receives treatment from the MSF clinic in Moreh. Thongsei is HIV positive and has been a patient at the MSF Clinic in Moreh since 2012. 
Thongsei used to work in charcoal and cultivation. Since he contracted HIV, his health has deteriorated and he is no longer able to do manual labour. He has seven children; the oldest is 17 years old and the youngest one 14 months old. Mary takes care of the children. Thongsei contracted HIV through drug use: Lupho had used drugs in the past to gain social acceptance in an area where tribal tensions had fostered a lack of trust amongst people.
He first visited the MSF clinic because he thought he had TB. By that point, he had stopped taking drugs and married. He was in fact diagnosed HIV-positive. His failing strength meant he was no longer able to work. He was afraid of discrimination and isolated himself. He thought he could no longer mingle with other people in public spaces. His eldest daughter, Lamknohat, and several of his other children are also HIV-postive. Lamknohat feels ashamed and doesn’t want other people to know.
Thongsei Lupho, who is living with HIV and receives treatment from MSF's clinic in Moreh, sits with his wife Mary, and some of their seven children inside their home. Manipur, India, April 2019. © Jan-Joseph Stok

Intravenous drug use is not uncommon in Manipur and according to the Manipur State Aids Society has contributed significantly to the spread of HIV and Hepatitis C in India’s Northeastern states. 

Thongsei Lupho (44) and his wife Mary have seven children. Thongsei is HIV positive and has been a patient at MSF’s clinic in Moreh since 2012. Some of his children are also HIV-positive. Thongsei and his son are going to the
Thongsei Lupho (44) and his wife Mary have seven children. Thongsei is HIV-positive and has been a patient at the MSF clinic in Moreh since 2012. Some of his children are also HIV-positive. Thongsei and his son are going to the

Thongsei and his son, who both live with HIV, are going to the “jungle”, the nearby forest, to fix the water pipes that provide water to the village. Even though Thongsei can’t work easily as someone living with HIV, he does his best to be active in his community. Manipur, India, April 2019.  © JAN-JOSEPH STOK


Tuberculosis is likewise highly prevalent, but in Manipur, which has experienced years of low-intensity conflict, state infrastructure has been unable to cope with the high number of HIV-positive and TB patients, particularly in cases of drug-resistant TB. This can have dire outcomes: in cases of co-infection, each disease speeds up the progress of the other, making the patient more vulnerable and their treatment more difficult. 

View of homes in Churachandpur. Many of the people live in the hills. One of MSF’s clinics is in Churachandpur. MSF started providing specialised care for HIV and TB in Manipur in 2005 and 2007, respectively. At its three clinics in Chakpikarong, Churachandpur and Moreh, MSF provides screening, diagnosis and treatment for HIV, TB, Hepatitis C and co-infections.  MSF, which is the only international NGO in Manipur, has put a patient-focused model of care at the heart of its operations in order to improve outcomes and minimise the spread of the diseases. Along with treating partners of co-infected patients, MSF also treats hepatitis C patients who are mono-infected in an opioid substitution therapy (OST) centre in Churachandpur. At the same clinic, people who inject drugs can pick up clean needles and turn in their used ones, helping to reduce the risk of needle-sharing and further infection.
Additionally, MSF supports the district hospital in Churachandpur by treating the HIV cohort for hepatitis C.

MSF started providing specialised care for HIV and TB in Manipur in 2005 and 2007, respectively. At its three clinics in Chakpikarong, Churachandpur and Moreh, MSF provides screening, diagnosis and treatment for HIV, TB, Hepatitis C and co-infections. 

MSF, which is the only international NGO in Manipur, has put a patient-focused model of care at the heart of its operations in order to improve outcomes and minimise the spread of the diseases.

“One of the simple ways we’ve tried to reduce the spread of drug-resistant strains of tuberculosis is to bring care to the patient instead of making them come to us,” says Edoardo Nicolotti, MSF Project Coordinator.

“When someone is newly diagnosed, we visit them at home to carry out an infection prevention and control assessment. If they live with family, we offer to build a simple house for them near to the family house. This greatly minimises the risk of transmission to others but keeps the patient close enough to maintain normal interaction.” 

Neilam Synrem, who is receiving treatment for MDR-TB, talks to an MSF counsellor in front of the house MSF built for her next to her family home, in order to reduce the chances of transmission of the disease to the rest of her family. Manipur, India, April 2019.
© JAN-JOSEPH STOK
Neilam Synrem, who is receiving treatment for MDR-TB, talks to an MSF counsellor in front of the house MSF built for her next to her family home, in order to reduce the chances of transmission of the disease to the rest of her family. Manipur, India, April 2019. © JAN-JOSEPH STOK

MSF has built nine such houses in 2018- 2019. MSF also sends a nurse to the patient’s house every day to carry out tests and ensure they are sticking to their treatment, which involves a challenging cocktail of drugs over roughly two years. Since DR-TB medication causes significant side effects, making it difficult for patients to complete treatment, MSF also provides counselling to encourage better outcomes.

"One of the simple ways we’ve tried to reduce the spread of drug-resistant strains of tuberculosis is to bring care to the patient instead of making them come to us.”
- Edoardo Nicolotti
MSF Project Coordinator

“One of the simple ways we’ve tried to reduce the spread of drug-resistant strains of tuberculosis is to bring care to the patient instead of making them come to us,” says Edoardo Nicolotti, MSF Project Coordinator. “When someone is newly diagnosed, we visit them at home to carry out an infection prevention and control assessment. If they live with family, we offer to build a simple house for them near to the family house. This greatly minimises the risk of transmission to others but keeps the patient close enough to maintain normal interaction.” MSF has built nine such houses in 2018- 2019. 

MSF also sends a nurse to the patient’s house every day to carry out tests and ensure they are sticking to their treatment, which involves a challenging cocktail of drugs over roughly two years. Since DR-TB medication causes significant side effects, making it difficult for patients to complete treatment, MSF also provides counselling to encourage better outcomes.

Patients of the opioid substitution therapy programme in Shalom hospital sit in the waiting room. MSF works with Shalom hospital, with patients receiving therapy from MSF and syringes from the hospital as part of a needle exchange programme. Manipur, India, April 2019. © JAN-JOSEPH STOK
Patients of the opioid substitution therapy programme in Shalom hospital sit in the waiting room. MSF works with Shalom hospital, with patients receiving therapy from MSF and syringes from the hospital as part of a needle exchange programme. Manipur, India, April 2019. © JAN-JOSEPH STOK

Along with treating partners of co-infected patients, MSF also treats mono-infected hepatitis C patients at an opioid substitution therapy (OST) centre in Churachandpur. At the same clinic, people who inject drugs can pick up clean needles and turn in their used ones, helping to reduce the risk of needle-sharing and further infection. 

Additionally, MSF supports the district hospital in Churachandpur by treating the HIV cohort for hepatitis C. In 2018, MSF started using a new drug, bedaquiline, in the treatment of patients with extensively drug-resistant TB. Since January 2019, 120 new patients were started on ARVs, 36 HIV-HCV co-infected patients are being treated for HCV, and 133 patients were started on treatment for drug-sensitive or drug-resistant TB. Currently, three MDR-TB patients are on the new treatment regimen (bedaquiline and delamanid), with the rest on the older two-year regimen.



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