'We are not afraid enough of Tuberlosis,' says professor

2008-07-01 00:00

We are not afraid enough of tuberculosis (TB). That was the warning from Professor Anton Stoltz, director of the Centre for Disease Control, at the first national TB Conference that opened at Durban’s ICC yesterday.

Speaking alongside national Minister of Health Dr Manto Tshabalala-Msimang and other dignitaries, Stoltz said the country needed to increase the TB cure rate, improve the Direct Observation Treatment (DOTS) programme and increase infection control in hospitals and clinics. Without the latter, he warned, there would be a serious spread of TB, especially multi drug resistant (MDR) and extremely drug resistant (XDR) TB.

According to Stoltz, it could cost as much as R50 000 to clear each case of MDR TB. Treatment for ordinary TB was approximately R377 per patient. However, this escalated to at least R31 000 with MDR TB — a figure that did not include hospital, laboratory and human resource costs.

This meant that prevention was the only meaningful option.

Stoltz asked a number of searching questions including whether the actual figure given for the number of MDR TB cases was correct at about 10 000. He pointed out that it was estimated that 20% of TB cases were drug resistant, which suggested that the figure could be closer to 90 000.

More importantly, he questioned why, when it was possible to cure 96% of TB cases, the local cure rate was at around 50%. He asked why some clinics had registered extremely high success rates and others particularly low ones? He asked why so much data was missing — at least 27% of patients don’t return and there is no data to indicate whether they were either cured or died.

He warned that the “window of opportunity to cure TB” was closing and urged all stakeholders to help put in place an effective DOTS programme that would prevent MDR TB from occurring by ensuring that people completed their treatment programmes. While he noted that the South African government was investing both meaningfully and substantially in fighting TB, he said the money had to go to where it mattered most – helping people understand the disease. This, he said, would persuade them to take their medication.

Both Stoltz and Dr Okey Nwanyanwu, from the Centre for Disease Control and Prevention’s global Aids Programme, pointed out that TB and HIV/Aids could not be separated. “One person, two diseases, one response,” was how Nwanyanwu summarized the situation, stating that it was time to institute a one stop shopping solution in a country where there was a 60 % TB/HIV co-infection.

He pointed out that South Africa was moving cautiously towards a single treatment solution and said that by positively influencing each other, treatment of these diseases would be central to strengthening primary health care.

The national Health Minister, whose opening address was accompanied by a low key demonstration by the Treatment Action Campaign, acknowledged that “TB is curable even in the presence of HIV and AIDS.” She added: “The key to reaching our national TB outcome targets is to diagnose early and treat completely… We must turn off the tap. This means reducing defaulter rates and increasing cure rates.”

Thsabalala-Msimang was speaking after an announcement that South Africa would acquire state-of-the art diagnostic technology that would narrow the diagnosis of drug resistant TB to just seven days as opposed to almost four months with current technology.

Although TB remained one of the major health care challenges facing South Africa, she said it nevertheless appeared that the number of people infected was leveling off with 337 641 cases reported in 2007, down from 341 165 in 2006. She said she was confident the department would reduce the TB defaulter rate from 10 to seven percent as promised by President Thabo Mbeki during his State of the Nation address.

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