World TB Day is observed on 24 March each year. This year’s theme ‘Invest to End TB. Save Lives’ was created with the urgent need to invest in resources to ramp up the fight against the disease. 

As the world marks World TB Day today, one of the few drug-resistant patients in South Africa has expressed relief at being able to be treated with the shorter oral regimen, BPaL, comprised of bedaquiline, pretomanid and linezolid. 

Instead of the usual 18 months, Bruno Da Silva can now be treated for drug-resistant tuberculosis (MDR-TB) in six months.

A daunting diagnosis

Da Silva, who resides in Johannesburg South in Gauteng, was diagnosed last September and was immediately put on the new shorter-oral regimen.

“Before being diagnosed, I had consistent pains on the right side of my chest, and I was coughing badly for approximately three to four weeks. I also used to sweat a lot at night while sleeping,” said the 24-year-old. 

He added: “To be honest when I was diagnosed with the disease, it was very difficult to accept. Especially when I was told that I had to start with the treatment immediately, which meant having to stay at the hospital.” 

The World Health Organisation (WHO) states that tuberculosis strains with drug resistance (DR-TB) are more difficult to treat than drug-susceptible ones. This threatens the global progress towards the target set to end TB. 

Da Silva, who is in the last month of the treatment, said that he only had to spend three months at the Sizwe Tropical Diseases Hospital, in Johannesburg.

“No one likes to be hospitalised for that long, but I was treated very well, and the nurses there were also good to me. But the worst part of being at the hospital was that I missed my family daily and I used to be afraid that I might have infected them. But, I was relieved to discover a few weeks later that no one else was infected,” said Da Silva. 

Thankful for new treatment

According to the TB Alliance that developed the shorter BPaL regimen, TB is the leading infectious cause of death in the world after COVID-19, killing 1.5 million people each year. The disease also claims a life around every 22 seconds. However, Da Silva said that he feels fortunate to have received the shorter-oral regimen without any side effects. 

“I am fortunate enough to be among the few people who are receiving the shorter treatment (shorter-oral regimen),” said Da Silva.

He continued: “But the best part is that I only have to take a few tablets a day, compared to what I might have had to take. At the moment, I’m feeling better, healthier, and stronger. I look forward to completing my treatment in the coming weeks.”  

Earlier this year, Health-e News reported how the much-anticipated rollout of the shorter oral regimen has failed to make an impact with only 70 patients having received the treatment. Only four provinces have this treatment available.

Da Silva, an English student at ABC International, said he had to temporarily drop out of school.

“Besides having to drop out of school for a while, I also had to spend months apart from my family,” he explained. 

“To those who are currently battling TB, my advice to them is that they must never lose faith. They must also ensure that they eat something before taking their medication daily,” said Da Silva.

Initial concerns eased

Olita Sebolai, from Refilwe in Cullinan, shared her father’s journey, who like Da Silva, also received the new treatment.

But, they were initially concerned when the doctors requested his permission before starting the treatment as they assumed it might be risky.

“My 66-year-old dad (Samuel) was first diagnosed with MDR-TB in early May in 2021 at the Cintocare hospital. He was soon transferred to Sizwe Disease Tropical Hospital to start the new treatment,” she explained.  

“They requested his consent to put him on the shorter-oral regimen which he was on for 9 months. He was worried at first but in the end, everything went well. He was discharged last October when his TB test came back negative. And until today, his test has been negative ever since,” Olita said.

A tough experience

However, she described how her dad suffered during the first few weeks; bad coughing spells which were sometimes bloody.

“Things luckily changed for the better and he’s doing well at the moment. Life has returned to normal but he still goes to Sizwe for monitoring purposes since he’s no longer taking any TB medication,” she said.

The 32-year-old said that although they are relieved that he’s okay, it was very tough at times. His family was unable to provide any moral support due to COVID-19 restrictions. This meant that they were only able to see him through a glass window.

“They also only allowed us to visit twice a week, which wasn’t enough since we didn’t know what we were dealing with. My dad is the first person to contract TB in our family,” she added. 

SA on the right path

Dr. Norbert Ndjeka, Chief Director of TB Control and Management at the National Department of Health, said that the country is headed in the right direction. But their strides are also marred with challenges such as finding new TB cases.  

“We are also struggling to care for those who are diagnosed. Retention in care is a huge problem and there is still room for improvement as the world marks World TB Day,” said Ndjeka.

He also expressed his satisfaction with the progress made with the new MDR-TB treatment.

“We used to treat our MDR-TB over two years. This was shortened to 9 months in 2017. And then in 2018, we reached a milestone with the new injectable treatment which was troublesome and also still 9 months for most patients. We then decided that 70% of our eligible patients will continue with the nine-month regimen. When we say long regimen, it’s 18 months and not two years,” the doctor added. 

Shorter regimen ‘going well’

Ndjeka confirmed that since the rollout of the shorter regimen started, the death rate among drug-resistant TB sufferers has dropped. More people have also returned to care.

“Now the shorter regimen means six months which is a further reduction. You need to start somewhere and see what works and learn a lesson.  So far, the program is going on well. Although, I must say, because of COVID-19, the intake is slower than what we had expected but patients like it. They are enjoying it,” said Ndjeka.  

“The most obvious benefit from this regimen is the proportion of those cured has increased and the death rate has gone down. Those lost to follow-ups have also gone down and we are able to return people to care. We will at some stage, speed up the process of enrollment,” he concluded.

According to the 2021 edition of the Global Tuberculosis Report, the most obvious COVID-19 impact is the large global drop in newly-diagnosed TB cases. In contrast, figures increased between 2017 and 2019, but when the pandemic kicked in, there was a fall of 18% between 2019 and 2020. Identified cases dropped from 7.1 million to 5.8 million. – Health-e News