Public Health & Health Systems Tuberculosis (TB)

Editorial: Decentralise treatment for drug-resistant TB

Written by Kerry Cullinan

Decentralised treatment of people with drug-resistant TB reaches more patients and is cheaper – yet government is dragging its feet to implement this approach, which it adopted as policy in 2011

Anyone can get drug-resistant tuberculosis DR TB from being sneezed or coughed on by the estimated 14 000 people who are infected, even if we have never had TB before.

Treatment for DR TB can take up to two years, is costly and often painful with some awful side effects – particularly if a person has extensively drug-resistant (XDR) TB.

The USA is inclined to keep people with DR TB in hospital in isolation wards until they have finished their treatment.

Yet South Africa has found that the most successful way of treating people with DR TB as outpatients at local clinics.

This might sound dangerous for patients’ families – but research has found that people are more likely to accept treatment if they can stay at home. Their families would have been exposed to TB already anyway, and once people have been on treatment for a few months, they are no longer infectious.

In places where hospital is the only way a person can get DR TB treatment, less than half of those who need treatment are likely to get it. There are long waiting lists for beds and many patients are daunted by having to spend six months in hospital.

Yet in Khayelitsha in the Western Cape, where people can get DR TB treatment at their local clinic then go home, around 90 percent of people who need it are on treatment, according to a report by Medicins sans Frontieres (MSF). The medical humanitarian organisation has been treating TB in the township since 2007.

Not only does the Khayelitsha programme reach more people but it is 40 percent cheaper than hospitalisation.

Based in part on the success of the Khayelitsha programme, the Department of Health (DoH) introduced a national policy of decentralised DR-TB care in 2011, enabling patients to be treated by primary health clinics, instead of in hospital.

But after four years, only 70 health facilities countrywide offer DR TB care instead of the 2 500 sites promised, according to MSF.

Urgent attention needs to be paid to decentralising treatment reach those who need care and to protect those still uninfected.- Health-e News


About the author

Kerry Cullinan

Kerry Cullinan is the Managing Editor at Health-e News Service. Follow her on Twitter @kerrycullinan11