Rita’s Fight

Rita is a young woman in southwest Uganda who has been living with HIV since birth. Both her parents died from AIDS-related illnesses. But with the support of her grandmother, Rita has adhered well to her prescribed antiretroviral (ARV) medication, which treats HIV. She was thriving—until a terrible cough started.

Grandmother Betty was puzzled by Rita’s cough, rapid weight loss, and swollen lymph nodes. She asked Rita to sit in the sun on the top of a hill every day in hope that the warmth would improve her health. But Rita just got sicker.

Health workers at local clinics were unable to diagnose the cause of the illness. They believed that Rita’s health problems were related to her ARVs—perhaps she was suffering because of poor adherence to medication. Rita and her grandmother knew that that was not the case. So they eventually found money and hired a motorcycle taxi (boda-boda) to transport Rita to Rwashamaire Health Center IV, which is supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) through the USAID RHITES-SW project.

“We didn’t know if Rita would make it,” says Sister Marion Nahabwe, the vector control officer. “She was so thin, and could barely breathe.”

Upon initial inspection, these health workers also believed that Rita’s illness was related to her failure to take her ARVs. “However, because we had been trained to diagnose and treat HIV/TB co-infection, nurses on the wards were quick to request a tuberculosis (TB) test before any ARVs adjustments were considered,” says Marion. A sample was sent for testing with Gene Xpert, which is an effective TB test that can also identify drug-resistant TB.

Rita tested positive for TB.

Her grandmother cried with relief. While TB is usually fatal if untreated, a medication regimen can usually cure it if caught in time. The clinicians made sure that Rita’s grandmother was also tested. This is known as contact tracing, whereby all people who may have come into contact with the patient are traced and the spread of the disease curtailed. Rita’s grandmother tested negative.

Rita is one of the many patients who is coinfected with HIV and TB—and misdiagnosed.

HIV is the leading risk factor for development of Tuberculosis (TB, which is the leading cause of death among people living with HIV. Ntungamo district, where Rita lives, has the highest number of drug-resistant TB cases in the region.

Through the USAID RHITES-SW project, EGPAF is at the forefront of the battle against TB in Southwest Uganda. Working with the Ministry of Health, EGPAF is strengthening diagnosis and treatment skills of health workers to save the lives of co-infected individuals.

Rita has since become a favorite client at the health center,” says Sister Marion. “She was strong-willed, and we all wanted her to make it. We made sure she got nutrition therapy to help build her strength up. She was already sleeping under a net to protect her from getting malaria.”

Today Rita is healthy, looking forward to school and helping out her grandmother take care of their garden and home.