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.
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 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.
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.”
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,” 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.
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.
