This is according to a report released by Médecins Sans Frontières (MSF) alongside the Western Cape Provincial Health Department on the eve of World TB day about a joint pilot project.

The report reflects on the impact of the pilot programme aimed at providing decentralised patient-centred care as well as support for drug-resistant tuberculosis (DR-TB) patients in the area.

A township burdened with a high prevalence of TB, Khayelitsha accounts for a 1,500 per 100 000 people per year infection rate – the highest in the world. The TB/HIV co-infection rate reached 74% and an antenatal HIV incidence of 30% in 2007.

Escalating numbers of DR-TB have placed a lot of strain on hospitals nation wide as they are using the standard practice of admitting patients that are diagnosed with DR-TB – they run out of beds making it hard to admit more patients.

Dr Virginia Azevedo, Khayelitsha Sub-District Manager who was wearing a mask during the event, revealed that the situation is a stumbling block for eradicating the prevalence of the bacteria. Stating that due to the length of the treatment programme patients admitted to hospitals escape from the premises before finishing their regimen because they need to be around their families.

‘€œThere is no need in creating special treatment centres without following proper procedure and ensuring that treatment is taken properly. Patients staying with their families makes it easier for others to come forward and seek treatment’€, said Azevedo.

The length of the treatment programme and side effects from taking the medication also present an enormous challenge to patients. Being admitted to hospital makes these harder to deal with especially since most patients are bread winners in their families.

Busi Beko, MSF DR-TB Adherence Councillor who was once diagnosed with both HIV and DR-TB while pregnant shared the difficulties she faced after her diagnosis especially since no counselling was available and was told she needed to be admitted to hospital.

Beko highlighted the need for patients and their families to get counselling after diagnoses and urged families to support those infected with the bacteria. She added that there is a lot of stigma still attached to being infected with DR-TB and that proper education will help eliminate stigma.

‘€œI was told that I had the DR-TB and that I had to stay in hospital for 24 months or more. Other people who knew that I had the bacteria would tell me that I have a killer TB that people are dying from.

‘€œOur counselling group at the clinic does house visits to patients and families. We tell them about different forms of TB and preventative methods they can take to avoid infection transmition when leaving with a DR-TB patient. This method helps since people discriminate due to lack of knowledge about the DR-TB.’€, she said.

She added that treatment side effects present an even greater challenge since some patients get deaf from the six months injection they have to endure every day while pills provoke nausea causing patients to vomit after taking them. This makes it harder for patients to finish the 24 month treatment programme.

According to Dr Eric Goemaere, MSF Medical Coordinator in South Africa, most DR-TB transmission takes place before patients are diagnosed and started on treatment. He expressed the need for better rapid tools to detect the DR-TB earlier and less toxic, better tolerated and more affordable drugs to treat patients. ‘€“ Health-e news service.

The full report is available at http://www.msf.org.za/Docs/Khayelitsha/MSF_DR_TB_Report_March_2009.pdf