If South Africa wants to contain new tuberculosis infections, it should treat the growing number of patients with drug-resistant TB in their communities rather than incarcerating them in hospital wards.
In addition, the country needed to treat the dual infections of HIV and TB as one epidemic, as at least half of people with HIV also have TB.
This is the call from activists and one of the country’s top infectious disease experts on the eve of the 38th Annual Union World Conference on Lung Health in Cape Town.
Professor Greg Hussey, Director for the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town (UCT), said there was an urgent need for a change in mindset if the country wanted to curb the rate of 250 000 new TB infections every year.
Speaking as ‘a supporter of the Treatment Action Campaign (TAC)’, Hussey said a key factor fuelling the multi-drug resistant (MDR) TB epidemic, was a lack of tools to make a quick diagnosis.
South African patients can wait for 28 to 56 days for an MDR diagnosis to be confirmed. For many this is the difference between life and death.
‘Our people are dying while they wait for their results from the laboratories,’ confirmed Neliswa Nkwali of the TAC in Khayelitsha.
Nkwali claimed there were currently 220 diagnosed MDR patients in the community but only four had been cured.
Boniswa Seti of the TAC’s Western Cape branch said it was critical for communities to play an active role in prevention and treatment programmes and for services to be decentralized to community level.
Hussey agreed that the TB programme was not reaching the people it needed to reach as treatment for MDR still involved months of incarceration in TB hospitals.
In the past, he added, patients with MDR TB tended to be ‘bloody difficult and had MDR because they had defaulted on their medication’ and that hospitalisation ‘was the only way to manage them’
‘That strategy now needs to be changed. We need facilities in the communities where people can be treated,’ said Hussey, adding that MDR and extensively drug resistant (XDR) TB was often spread in hospitals themselves.
Seti said TB hospitals such as Brooklyn Chest Hospital in Cape Town did not have enough beds to treat the number of people in need of treatment.
‘We need to treat in the communities instead of saying that we will only rely on Brooklyn,’ she said.
Gregg Gonsalves of the AIDS Rights Alliance for Southern Africa said people living with HIV needed to be tested for TB. ‘We need to make it easier for them to be tested. We need to make it easy for them to deliver their sputums, maybe drop-off points at schools or taxi ranks,’ he said.
Gonsalves said it was also critical to ‘push infection control measures’ such as opening windows in taxis and clinic waiting rooms and urging people to cover their mouths when coughing.
‘Yes, we need new drugs and diagnostics, but we can cure and prevent TB with what we have,’ said Gonsalves.
Currently South Africa’s national health department manages TB and HIV as two separate infections with separate clusters and separate heads. Sources said there were only six people in the national TB department with more than 10 unfilled vacancies.
Activists will be marching to the conference on Thursday calling on leaders, scientists, researchers, politicians and other participants, to support a global call to action on TB.
TB is preventable and has a cure. Despite this two million people die of TB a year. ‘ Health-e News Service