TB study to help patients breathe again

In 2007 tuberculosis killed 1.7 million people throughout the world which translates to one death every 20 seconds. Now South African scientists are on the frontline of the battle against the dangerous drug-resistant and multidrug-resistant tuberculosis, writes S'THEMBISO HLONGWANE.

WE are trapped like flies in a jam jar,” laments a 25-year-old extreme drug-resistant tuberculosis (XDR) patient from Umlazi, south of Durban.

“Since last November I have been held here almost like a hardened criminal. My life is on perpetual hold. This is not a hospital but a detention centre. I cannot even continue with my tertiary education.”

A 40-year-old male multidrug-resistant (MDR) tuberculosis patient from Melmoth, northern KwaZulu-Natal complains: “I miss my family. Life here is boring. All we do is eat, sleep and take medication and occasionally watch TV. It’s a monotonous unending cycle.”

Both these patients, who do not want to be identified, are receiving treatment at Friends of the Sick Association (Fosa) TB hospital in Durban.

Last Thursday, perhaps frustrated with extreme prison-like treatment that includes a daily dose of 12 tables, they staged a lunch-hour demonstration demanding free passes.

Their act of civil disobedience comes just months after 29 MDR and 20 XDR patients at the Jose Pearson Hospital in Port Elizabeth escaped by cutting through three of the hospital’s perimeter fences. Later some voluntarily returned to the institution, while others were captured by police.

Normally patients with non-drug resistant TB are treated as outpatients and they are encouraged to continue with their six-month course treatment.

But with the emergence of the drug-resistant TB strain, government introduced a policy which forces these patients – who in all probability pose a public health risk – to stay at a TB hospital and be isolated from their families.

This also helps to monitor patients who do not take the full course of their prescribed medication.

According to research, 60% to 70% of drug-resistant TB strain cases can be treated with existing drugs but up to 40% cannot.

The drug-resistant TB strain is exacerbated by patients not completing their full six to nine month drug regimen. Last year 12% of the more than 300 000 South Africans treated for TB died.

But all is not lost.

Scientists at the Council of Scientific and Industrial Research (CSIR) are searching for a way to break the multidrug-resistance of this TB.

Among the cures is a new slow-release tablet that allows TB patients the pleasure of taking one pill a week as opposed to the cocktail they are currently subjected to.

Dr Hulda Swai, a senior researcher at CSIR’s materials science and manufacturing office, says the new drug delivery mechanism aims to shorten the duration of treatment “which will substantially improve patient compliance”.

The mechanism is currently going through pre-clinical trials.

Swai says diseases such as TB, malaria and HIV/Aids, which contribute significantly to the high mortality rate on the continent, can be treated successfully.

“Improved drug delivery will therefore impact on a range of socio-economic issues, including economic growth and poverty reduction,” she says.

Her project is a joint research initiative between the CSIR and a number of universities and research institutions, both international and local, including Nottingham and Cardiff universities in the UK.

Swai’s colleague, Dr Sidney Parsons, is working on a prototype that can be used to control or minimise the spread of airborne diseases like TB at healthcare facilities.

Parsons says their objective is to look at how they can build a safe and healthy environment.

“We are looking at how we can give the patients an opportunity to finish schooling while still at the hospital. Our approach is not to lock them inside a room but to give them an environment that is a home away from home. That can go a long way in improving their health,” he says.

Parsons says the department of health is finalising the list of TB hospitals that will be refurbished.

These will be in Eastern Cape, North West, the Northern Cape, Limpopo, KwaZulu-Natal, Free State and Mpumalanga.

He says conventional construction materials will be used, however the construction methodology, while ensuring compliance with the regulated procurement processes, is where time will be saved.

In addition, the designs will address not only the need to fasttrack the process but the important issue of long-term patient care, needs and dignity.

“The aim is to ensure that an additional 280 beds will be provided for the MDR-TB facilities by the end of 2010,” says Parsons.

While Tuesday, March 24, has come and gone as World TB Day, what can individuals do to prevent the spread of TB?

The World Health Organisation is working at reducing TB prevalence rates and deaths by half by 2015.

So while scientists are working hard to find the next wonder drug, families of TB patients are encouraged to improve ventilation in their homes.

Members of the public are also encouraged to visit a health facility for a free TB sputum test if they experience a persistent cough, tiredness, night sweats and weight or appetite loss.

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