KHOPOTSO: The emergency meeting on XDR TB was convened by South Africa’€™s Department of Health and included experts from the World Health Organisation (WHO) as well as southern African and local leaders in the diagnostics and management of Tuberculosis. The meeting follows the identification of more cases of the Extremely Drug-Resistant strain of TB, which first surfaced in KwaZulu-Natal, in more parts of the country. It was chaired by the Health Department’€™s Director-General, Thami Mseleku.

THAMI MSELEKU: Not all provinces have been able to actually get to the level of identifying these. Of those provinces that have identified these, in Gauteng we have nine cases that have been identified, in the Free State we have six cases that have been identified, in Limpopo we have suspected cases ‘€“ three ‘€“ which are unconfirmed yet, but laboratory tests are being actually done and in North West we have 10 cases. These are officially confirmed cases. The other provinces may have suspected cases’€¦ There’€™s 78, I think, in KwaZulu-Natal. And these are based on hospital and lab records.                      

KHOPOTSO: As TB is directly linked to HIV/AIDS, the emergence of XDR TB has had those working in HIV and AIDS care concerned about the impact it could have on the government’€™s AIDS treatment programme. But curiously though, in his opening address at the meeting, Mseleku made no mention of the word HIV or even AIDS and its direct link with TB. And the rationale for that is?

THAMI MSELEKU: Because of the stigma associated with HIV and AIDS we mustn’€™t push our people with TB and TB signs to be immediately saying ‘€˜I won’€™t go to hospital because then, they may actually find that I’€™m HIV-positive’€™, whereas they could have gone to hospital and understood that we can still treat TB even in the context of HIV and AIDS. It’€™s important for us to actually make that point because our people, as we know them because we live here, actually will avoid going to hospital if we begin to say ‘€˜by the way, the minute you cough for two weeks that might be a sign that you have TB and, in fact, might be a sign that you are HIV-positive’€™. That’€™s very important to make the point so that when we send these messages we say, ‘€˜it does not necessarily follow’.

KHOPOTSO: He added that it’€™s important that the emergence of XDR TB does not result in a shift from the country’€™s HIV testing policy of Voluntary Counselling and Testing. Meanwhile, the registrar of medicines Mandisa Hela, says the Medicines Control Council is fast-tracking registration of two drugs needed for the treatment of XDR TB. These are drugs that had previously been in use but have been excluded due to low efficacy or strong toxicity. In four decades no new TB drugs have been developed.

MANDISA HELA: (There are) two of them that we don’€™t have registered yet, that is, Capreomycin and Para-Amino Salicylic Acid. Capreomycin at the moment is being fast-tracked for registration; for para-amino salicylic acid we don’€™t have an applicant, yet. However, we have made arrangements under a section in our law that enables us to import an un-registered drug under certain conditions. We have imported Capreomycin. It is available in the country. Para-Amino Salicylic Acid, we will be able to have in the country within the next seven to 10 days.            

KHOPOTSO: In the context of a country with a highly-concentrated HIV epidemic such as South Africa, the availability of the two drugs could mean further challenges. Dr Ernesto Jaramillo, works with the WHO’€™s TB programme.

Dr ERNESTO JARAMILLO: All second line drugs have more of a higher frequency of drug-drug reactions. However, the evidence from many other countries where these drugs have been used for treating MDR TB and XDR TB indicate that these are drug-drug reactions that are relatively easy to manage, but requires a lot of work in the TB control programme – proper training to ensure early detection and to deliver treatment to manage  drug-drug reaction.        

KHOPOTSO: The Health Department’€™s Director-General admits that there has been an increase in the number of TB cases detected in South Africa over the years with a low cure rate of 50% and a high defaulter rate of 10 %. This has resulted in a high proportion of MDR TB cases and now, ultimately, XDR TB.

THAMI MSELEKU: We will be able to avoid a situation where this becomes so unmanageable by ensuring that we go back to the drawing board and insist that our people finish their treatment, our people do go to their clinics and we strengthen our services for evaluation of their sputa and everything else’€¦ for the majority of our people don’€™t have XDR TB, don’€™t have MDR TB. They do have TB which can still be cured even in the context of HIV.

KHOPOTSO: The two-day emergency meeting held in Pretoria this week is an admission that South Africa needs help to handle the looming crisis of XDR TB. The Health Department’€™s decision to convene the meeting, says the WHO, is the first step towards dealing with the problem. Dr Mario Raviglione.

Dr MARIO RAVOGLIONE: I don’€™t want, unnecessarily, to praise the government of South Africa. But it must be recognised that South Africa moved quickly this time on this issue.