TB: Hard slog ahead

2012-06-23 15:06

The good
The Western Cape has enjoyed great successin treating – outside hospitals – patients suffering from multi-drug resistant tuberculosis (MDR-TB).

Traditionally, TB patients are hospitalised in special units or at dedicated TB hospitals and have to undergo rigorous treatment and, effectively, quarantine.

Working with Médecins Sans Frontières, the provincial health department started treating MDR-TB patients at all its Khayelitsha clinics in 2007 as part of a three-year pilot project.

The project worked so well that last year, all Western Cape clinics started treating MDR-TB patients.

What the three-year project revealed was that decentralising the care and treatment of MDR-TB significantly increased the number of patients treated and reduced new infections.

Pamela Richards, deputy director for multi-drug resistant TB, TB and HIV at the national health ministry, told delegates at the third SA TB conference last week: “The government is planning to expand the decentralisation to all clinics in the next five years in South Africa.

“We know that it’s an ambitious plan because (of the) shortage of healthcare workers, but it’s something we need to do because we have proof that it works.”

Dr Jennifer Hughes, who presented the pilot project findings to delegates at the conference, said: “Findings showed that initiating MDR-TB patients at clinics led to an almost 70% increase in the number of patients started on treatment between 2007 and 2010.

“It also showed that by decentralising care and treatment, patients were able to start treatment a month earlier than they would in a specialised hospital.”

The Western Cape has been South Africa’s worst-affected province in terms of MDR-TB in the past three years.

There were 2 200 recorded cases in 2008, 2078 in 2009 and in 2010, cases significantly decreased to 1 422.

Hughes added: “The decentralisation model may have had an impact in the reduction of new cases as people were now being treated earlier, therefore preventing the further spread of MDR-TB.”

The bad
The KwaZulu-Natal government is paying a heavy price for failing to heed the warning signs
of a possible tuberculosis (TB) pandemic nearly a decade ago.

The provincial government did not respond accordingly at the time and is now the nation’s TB and HIV capital!

In 2010, there were 404 929 cases of TB confirmed across the nation by the National Institute for Communicable Diseases. And 122 960 were recorded in KwaZulu-Natal.

David Mametja, chief director for TB control and management at the national health department, said:
“If KZN had accepted earlier that TB was a growing problem, maybe the situation would be different today.

“The government only realised it had a serious problem when there was an outbreak of extensively drug resistant TB in Tugela Ferry in 2006.”

The outbreak killed 52 people in a space of three weeks.

Dr Simphiwe Mndaweni, general manager for strategic health programme in the province, agreed: “As a result we were forced to go back to the basics and focus on proper management of TB to avoid the development of drug-resistant TB.

“We also learned the importance of strengthening integrated TB and HIV services and surveillance for drug- resistant TB.”

The epidemic has shown no signs of slowing since then. In the past two years, 241 871 KwaZulu-Natal residents were diagnosed with different strains of TB.

In fact, most were co-infected with HIV. More than 31 000 of those have since died.

With the above in mind, it’s not all doom and gloom for the province.

Dr Mndaweni said both the cure rate and the rate of patients defaulting on treatment had improved.

It’s not just KwaZulu-Natal that is grappling with high TB rates.

The Eastern Cape, Gauteng and Western Cape have also been hard-hit. For two consecutive years, Eastern Cape has reported the second highest number of TB cases – an average of 60 000 confirmed cases.

Mametja said: “TB is not a KwaZulu-Natal issue but a national problem. It requires all of us to work together because if we are not careful another province may find itself in the same situation as KwaZulu-Natal.”

The ugly
That province may well be Eastern Cape. If the health practitioners and those in charge of finances aren’t able to quickly increase the cure and prevention rates, the province could soon be at the epicentre of South Africa’s tuberculosis (TB) epidemic.

David Mametja, chief director for TBcontrol and management at the national department of health, told delegates: “If the Eastern Cape is not careful, it may find itself in the same situation as KwaZulu-Natal in the near future.”

The Eastern Cape currently records about 60 000 cases of TB a year. But Mametja said: “It could easily increase if the cure rate and the defaulter rate does not improve.”

The province’s cure rate was 63% in 2009 and increased to 67% in 2010.

But this remained far below the target of an 85% cure rate set by the World Health Organisation.

None of South Africa’s nine provinces have managed to hit World Health Organisation’s target in the past five years.

Only Western Cape has achieved an 80% cure rate within that period.

In 2010, the province reported the highest TB cure rate – 81.7% – in South Africa.

North West province reported the lowest cure rate at 66.6%, followed closely by Eastern Cape.

Miyakazi Nokwe, acting general manager for TB and HIV in Eastern Cape, said: “The department is busy implementing strategies to try and reduce the TB incidence in the province. Last year, we launched the intensified TB case-finding campaign.

“The aim of the campaign is to find new tuberculosis cases early, as well as trace those who have defaulted on treatment,” she said, adding: “It is too early to measure if the campaign was a success or not.

“We should be able to measure the difference made by the campaign at least by next year.”

The intensified TB case-finding campaign is a national initiative which was launched by Health Minister Aaron Motsoaledi last year.

The campaign is currently being rolled out across the nation in a bid to reduce the number of new TB infections as well as trace and cure all patients who defaulted on their treatment.

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