To be released in at least three parts, the new guidelines incorporate the latest guidance from the World Health Organisation (WHO) on the use of the country’s rapid TB GeneXpert test to diagnose TB outside of the lungs as well as in children.
Previously, the two-hour test had only been used to test samples of sputum, or mucous coughed up from the respiratory tract, to test for TB and assist in diagnosing multidrug-resistant TB (MDR-TB).
Now, samples of lung lining as well as fluid extracted from the spine and, in the case of children, the stomach can also be tested with the machine, according to the Department of Health’s Director for TB Control, Dr Lindiwe Mvusi.
The Department of Health has also created a separate, shorter guideline on treating TB in children for health workers although the country continues to battle a lack of paediatric formulations, Mvusi said.
“Since we do not have the correct formulations, we have had to provide clearer guidance on how to dose children,” said Mvusi, adding that the latest WHO recommendations showed that South Africa may have been previously under-dosing children with TB.
She added that the new guidelines also include renewed pushes for tracing close contacts of TB patients who may have also developed the disease as well as regularly offered screening at clinics. The guidelines also feature new indicators to allow the country to better track how long patients screened with GeneXpert take to start treatment and how many of them are actually started on treatment.
“This is a new technology and we need to get a sense of whether this makes a difference in patient outcomes,” Mvusi said.
According to a Human Science Research Council (HSRC) study presented last week in Cape Town, the GeneXpert had dramatically cut the time it took to MDR-TB patients onto treatment since it was introduced in 2011. However, researchers note that patients still waited more than the national target of five days. Also, the microwave-sized machine has yet to increase the number of TB cases diagnosed annually as compared to traditional TB testing, according to the HSRC.
South Africa becomes second in world to adopt three-year IPT[quote float=”right”]”Since we do not have the correct formulations, we have had to provide clearer guidance on how to dose children”
New guidelines on the prevention of TB are also expected to be discussed at the conference. Isoniazid preventative therapy (IPT) uses one of the drugs used to treat TB to active TB in those who have not yet developed it.
A six-month course of IPT is now required for children living with HIV who have been in close contact with a confirmed TB case however the new guidelines note that no child should be placed on IPT unless they have been exposed to a confirmed TB case first.
The guidelines continue to use reactions to tuberculin skin tests (TST) as initiation requirements for some patients, including people living with HIV who cannot start treatment if they have not been started on HIV treatment and have a negative skin tests.
Other patients are prohibited from starting IPT include those with liver disease and heavy drinkers.
Although the Department of Health first introduced IPT as part of guidelines as early as 2004, uptake of IPT has been slow. This may be in part because they were previously included as part of HIV treatment guidelines, according to Dr Gavin Churchyard, CEO of the Aurum Institute, which helped draft the new IPT guidelines.
Acknowledging the raging epidemic of TB in South Africa’s mines, the new IPT guidelines include how to use IPT with gold miners who also have silicosis. They also make South Africa the second country in the world to adopt a three-year course of the drug to prevent active TB, according to Churchyard.
Currently, a lack of long-term IPT clinical trials means that bodies like the WHO do not yet have data for how safe it is to use IPT for more than three years. The Aurum Institute is hoping to provide some of this data through future clinical trials, according to Churchyard – Health- e News Service.
An edited version of this story first appeared in the 10 June edition of the Cape Times.