In 2011, thousands of DR-TB patients could seek treatment at only 17 centres nationwide. If patients were lucky enough to secure a bed at one of these facilities, they faced a hard choice: Move away from family and home or die.

Today, almost 684 clinics and hospitals provide care for the tens of thousands of DR-TB patients started on treatment each year, according to figures announced at the SA AIDS Conference in Durban. This follows previous criticism by activists including the Treatment Action Campaign that government was moving too slowly to bring care and treatment closer to patients following a 2011 policy decision.

“We have at least one (DR-TB treatment) initiation site per district,” said Dr Norbert Ndjeka, head of the Department of Health’s division on HIV, TB and drug-resistant TB. “Decentralisation is our core business”

He added that the department will now focus on rolling out treatment to sub-districts, especially in the hardest hit provinces of KwaZulu-Natal, Gauteng, and the Western and Eastern Capes.

Linezolid tender being finalised

The Department of Health also announced that more than R130 million has been slated to introduce two new drugs, bedaquiline and linezolid, used to treat extensively drug-resistant TB (XDR-TB).[quote float= right]“We have at least one (treatment) initiation site per district. Decentralisation is our core business”

The first new TB drug in nearly five decades, bedaquiline was approved for use in South African patients in October. This follows a clinical access programme that out that found samples from about 60 percent of XDR-TB patients on bedaquiline were TB-free after two months.

According to Ndjeka, the Department of Health will allocate R130 million to roll out bedaquiline to at least 9,000 patients over the next three years through the ring-fenced HIV Conditional Grant. Although Ndjeka told Health-e News that a similar budget would be dedicated to introducing linezolid, he declined to give specifics as the tender is still being formulated.

About 150 patients have already received bedaquiline in provinces like Gauteng and the Western Cape. KwaZulu-Natal, Mpumalanga, Limpopo and the Free State have yet to start patients on the drug.

Currently, only 15 percent of XDR-TB patients are ever cured and current treatment regimens risk leaving about 60 percent of patients permanently deaf due to side effects if South African studies are an indication. To try and prevent deafness, health care workers must carefully monitor patients’ hearing. Unfortunately, the country’s 461 public sector audiologists sit mostly at large hospitals – away from patients’ clinics.

South African Dr. Dirk Koekemoer has invented the KUDUwave portable hearing test machines. More than 100 of these are currently being used around the country, according to Zerilda Claasen who works with the Department of Health

“We don’t have specialists everywhere so with the KUDUwave you can have a midlevel worker doing the screening,” said Claasen who  described the mobile system that uses video game controllers to test patients in clinics or even under trees. “In the case of the KUDUwave, we also have automated interpretation… you can test anywhere.” – Health-e News.

• Read more: XDR-TB patients smuggle pills as treatment priced out of reach
• Read more coverage of this week

Edited versions of this story first appeared in The Mercury and Pretoria News newspapers