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Interview with Lucy Chesire,
HIV/AIDS
Nutritionist, MOI Teaching and Referral
Hospital, Nairobi, Kenya
Workshop on T-Cell Based Diagnosis of Latent
Tuberculosis Infection in Resource-Limited
Settings
16-17 March 2006, Geneva, Switzerland
 Lucy
Chesire is a health nutritionist from Eldorat, Kenya, as
well as the Community Representative on the
Coordinating Board of the STOP TB partnership. In 1992 Lucy
was diagnosed with HIV. Five years later,
she became the first female health professional to publicly
acknowledge having the disease. Determined
to help individuals facing a similar traumatic experience,
she has become a key figure in the TB-HIV
activist community.In 2000, Lucy started experiencing persistent coughing,
weight loss, night sweats and loss of appetite. An
x-ray revealed that she had tuberculosis (TB) in her chest.
This was shortly followed by TB of the lymph
nodes, which required surgical intervention. A month later,
while still in the hospital, her knees started to
swell. At first, doctors thought it was arthritis but it
turned out to be tuberculosis in the knees. Two more
operations followed.
In 2004, Lucy spoke at the fourth TB-HIV Working Group
Meeting in Addis Ababa, Ethiopia, and revealed
that the driving force behind her activism is her strong
desire to help people who are suffering from TBHIV.
Lucy often gives voice to her indignation at the limited
resources available to people who have
found themselves in similar life-threatening situations.
The main message of Lucy’s advocacy campaign is clear and
simple — it is effectively useless to tackle
HIV/AIDS without also addressing the threat of TB.
On March 16-17 of this year, a workshop entitled “T-Cell
Based Diagnosis of Latent Tuberculosis
Infection in Resource-Limited Settings” was organized by the
Foundation for Innovative New Diagnostics
(FIND), together with TDR, the WHO, and the Stop TB Working
Group on New Diagnostics. The following
is an interview between FIND and Lucy Chesire, who attended
the workshop along with participants from
all over the world.
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FIND: |
What is your
general impression of this workshop? |
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LC: |
Well, from a
layman’s point of view, this is a very
scientific, highly technical workshop
but it presents a lot of good
information, especially about the
progress being made in the development
of new diagnostic tests for identifying
latent TB, a subject that is very close
to my heart. |
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FIND: |
What do you
think of the usefulness of these new
tests with respect to early detection of
latent TB? |
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LC: |
Again, from
the perspective of a patient, the new
diagnostic tools that are being
introduced and discussed here are
extremely relevant. They are a step in
the right direction. Without new and
accurate diagnostics, we will not find
better vaccines against these deadly
diseases. This workshop serves as
another entry-point for the TB community
to access new tools for diagnosis. A
crucial factor here is the possibility
of diagnosing latent TB accurately,
since for HIV positive individuals, the
possibility of being TB positive at some
future point in time is very high. Early
detection means earlier treatment and
more effective cures.
Another
reason for the need for new and better
TB tests is that the tests available at
the moment are not highly sensitive,
that is, they do not detect enough
infected cases, nor are they specific
enough, which means they cannot
differentiate as accurately as they
should between positive and negative
cases. This gap between test sensitivity
and specificity needs to be sorted out. |
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FIND: |
Do you think
that the outcome of this workshop will
be useful in guiding policy in certain
highendemic countries? |
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LC: |
Well, on the
front page of the materials handed out
at this conference, it is stated that,
and I quote, “The meeting is not
intended to establish policy on the use
of these tests.” Perhaps they are
talking about policy as it relates to
the National Health Programs in African
countries. My main concern is that we
need more field studies in Africa where
the main burden of HIV/TB is found.
Funding is another serious issue. Are
there adequate funds available and, if
so, how do we get them to support FIND’s
and the WHO’s initiative to bring more
effective diagnostics to the public
health sector? |
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FIND: |
In light of
the high instance of HIV/TB in Africa,
do you have any recommendations for FIND
in terms of its mission to accelerate
the development and successful use of
these tools? |
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LC: |
Well,
besides its efforts in developing more
precise and effective diagnostic tests,
I would encourage FIND and other
organizations to work more closely and
actively with doctors and other public
health personnel in order to encourage
greater receptivity at the community
level. Treatment literacy must play a
larger role at this level so that
patients and family members can be
informed about the standard practice for
HIV management in terms of opportunistic
diseases like TB; about how to prevent
mother-child HIV transmission; about how
to manage cases of HIV positive
children; about the importance of a drug
program and the role nutrition and sound
life
style habits play for HIV positive
individuals; in other words, the
significance of the sociopsychological
support system should not be overlooked.
Furthermore,
on a more technical level, companies
developing diagnostic tools need to keep
in mind the different markets or groups
that will benefit from their tests, such
as children, mothers, expectant mothers,
HIV positives, and so forth. For
instance, I think that the blood sample
size for most patients is far too large
and should be reduced. Improved
diagnostics may make this possible.
Present reagents are often far too
expensive which may be a hindrance in
diagnostics research. I would like to
see FIND and other organizations
collaborating with industry to reduce
the price of these tests. And finally, I
feel it is very important to build up
the capacity of our labs in Africa so
that once new diagnostics are introduced
into the public health sector via our
National Health Programs, our
laboratories will be better equipped to
use these new tools. |
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