‘Not letting go’ is secret to high cure rate in Western Cape
‘Not letting go of the patient’ has been a key strategy which has paid off in the Southern Cape, where two districts have recorded cure rates in excess of 80 percent. Cloete ascribes this to the fact that patients on treatment are monitored and it is very difficult for them to default.
‘The TB programme is also run by driven and committed individuals,’ Cloete points out.
Eden district which includes Knysna, George, Plettenberg Bay, Oudtshoorn, Riversdale and Beaufort West had 5 366 TB patients in 2004 and managed to record a cure rate of 81,8 percent. The Overberg district which includes Caledon managed to cure 84,5 percent of its 2 437 patients in 2004. This is close to the World Health Organisation gold standard of 85 percent.
‘Obviously the Southern Cape had fewer cases than the Cape Metro for instance (25 824 cases in 2004 of which 64,8% cured), but they have done a fantastic job,’ adds Cloete.
Cloete overseas over 400 TB treatment points across the province with the Cape Town Metro responsible for the bulk of the TB services in the city.
Numbers in Cape Town have increased significantly at clinics in areas such as Khayelitsha and Nyanga where the TB epidemic is being fuelled by the HIV epidemic.
‘There is no doubt that more and more TB patients will have HIV, making it critical for us to integrate the two services. The reasons are clear, but we are grappling with how we can bring the two services closer together’ says Cloete.
Cloete said the drop in the cure rate was more pronounced in certain high burden areas. ‘The tipping factor is the increase in HIV. As the case loads increase you see a drop in cure rates,’ explained Cloete.
With this in mind, the province has committed increased funding to the TB programme which will be used to employ more staff, channel more money to the non-governmental sector for treatment supporters and increase capacity at the laboratories.
Five sub-districts have been singled out for special attention this year. These include the Breede Valley (Worcester), Drakenstein (Paarl), Eastern (Helderberg and Oostenberg), Khayelitsha and Klipfontein (Old Nyanga and Athlone).
In 2005 Klipfontein had 3 769 TB cases and Khayelitsha 5 640. Klipfontein recorded a cure rate of 67,9 percent and Khayelitsha 51,7 percent.
Cloete said although multi-drug resistant TB was a huge concern he believed that as long as the province was able to push the TB cure rate up the MDR-TB rate would come down. One percent of new cases in the province are currently MDR-TB while four percent of retreatment cases are MDR-TB.
The Western Cape has seen TB grow from 27 509 cases in 1997 to 47 603 in 2005.
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