Prioritizing some patients over others may be tough, but it is necessary if we are to beat the TB epidemic despite limited resources.

This is the logic of international experts who are urging South Africa to pour resources into curing new cases of ordinary tuberculosis (TB) rather than spending any more money trying to treat patients with multiple drug resistant (MDR) TB.

At present it costs R198 to treat a new TB patient and if the treatment is completed; the cure rate is 100%. Treatment for drug resistant TB, on the other hand, costs R28 000 and the chance of cure is about 50%.

“You should rather use that R28 000 to treat the multiple new cases of TB,” concluded Professor Don Enarson, who recently led a World Health Organisation (WHO) review team to the Eastern Cape.

“Pay attention to the new cases and fix them the first time around or they become retreatment and MDR-TB cases. MDR-TB can’t be cured as fast as it is produced. So, first we need to shut the tap and stop producing them, given the low cure rates [for MDR-TB].”

“No-one knows exactly how much MDR-TB there is, but it’s not a flaming epidemic. It’s a couple of hundred cases whereas there are 10 000 new TB patients in this [Eastern Cape] province alone.”

Despite the growing number of ordinary TB cases, Dr Ibrahim Hoosein, the Port Elizabeth District TB Co-ordinator, says that 70% of his time is taken up in meetings discussing drug resistant TB.

The Jose Pearson TB hospital is the only institution in the Eastern Cape
which provides free medication for multiple drug resistant TB patients. There are about 200 MDR-TB patients at Jose Pearson this month (November), almost half of whom are also HIV positive.

At the hospital’€™s Sunshine Children’s ward, Portia, a vivacious four year old, demonstrates her rendition of a super-model on the catwalk to applause from the WHO review team.

Sister Makapela with Portia

According to Sister Loretta Makapela, only one of the children in her care is HIV-infected. As it turns out, that child is Portia. She is also one of the two children at the centre with multiple drug resistant TB.

But if Portia stood out from the rest of the children in the pre-school, it was not because she has MDR-TB or, for that matter HIV, but because she is such a bright and beautiful child.

With proper care, says Sister Loretta Makapela, Portia could live to at least 8 or 10. Portia’s mother is also HIV positive. She phones every day and has special permission to stay over on the weekends with her little girl.

The logic of economics and the focus on prevention rather than cure which made perfect sense around the discussion table suddenly seem cruel and cold in the Sunshine Children’s Ward. Luckily for children like Portia, economics is not the only consideration at Jose Pearson, where everyone gets treated equally.

As TB infection continues to increase, however, tough decisions about prioritizing resources will have to be made. And according to Dr Refiloe Matji, National TB Manager of the Department of Health, the priority must be to cure new cases of ordinary TB and prevent new cases of drug resistant TB.

“We are faced with MDR-TB and the first thing we must do is make sure we don’t produce new cases. However much we debate it, we won’t get another answer,” says Dr Matji.

“The effective treatment and cure of ordinary TB is the best strategy for preventing the spread of MDR-TB. This is because MDR-TB is caused by the incomplete treatment of ordinary TB in the first place.” ‘€“ health-e news service

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