SA's plan to curb TB

South Africa's fight against TB has been complicated by its massive HIV infection rate, the Department of Health’s director general Thami Mseleku said at a press conference at the 38th Union World Conference on Lung Health.

The number of cases rose from 224 000 in 2002 to 342 000 in the year 2006.

South Africa is currently one of the four countries in the world – the others are China, Russia and India - with the largest concentration of TB sufferers with diagnosed drug-resistant strains of the disease.

TB and HIV
Mseleku said the Department’s new strategic plan for TB acknowledges the close connection between TB and HIV/Aids, and provided ways of dealing with the challenges of co-infection.

According to the plan, one of the goals will be "functional integration" of TB and HIV activities in health facilities.

"The focus will be to increase HIV testing uptake by TB patients, CD4 testing and assessment of all co-infected patients, provision of treatment and preventive therapy for other opportunistic infections and antiretroviral treatment for all co-infected patients," says Mseleku.

The plan also aims to strengthen the DOTS strategy, to improve infection control, and to "empower people with TB as well as communities".

Containing the disease
Mseleku said the Department is looking for ways to make it easier to commit people with drug-resistant tuberculosis to treatment facilities against their will.

Until now, health authorities had to get a high court order every time they wanted to commit someone who posed a danger to the community.

"We're still exploring the alternatives," he said. The department was looking for clauses in existing legislation that would allow "a general approach to the matter".

The department's chief director for TB, Yogan Pillay, said any new legislation could be modelled on the Mental Health Act, which allowed people posing a risk to themselves or others to be incarcerated, subject to judicial oversight.

"The extent of XDR-TB and the magnitude of the problem have serious public health consequences, not only for South Africa, but for the whole African region as well as globally," the strategy said.

TB a global threat
Though curable, more than 1.6 million people die of tuberculosis every year and growing numbers of patients do not react to standard drugs, the International Union Against Tuberculosis and Lung Disease said in a statement.

"Despite international efforts, the increasing incidence of multi-drug resistant tuberculosis (MDR-TB) and extremely drug-resistant tuberculosis (XDR-TB) threatens to push that number higher," it said. World-wide, 37 countries have recorded cases of XDR-TB – a near incurable form of the disease.

New drugs needed
No new TB drugs have been developed in more than 40 years and existing methods of testing are too slow to combat the extreme form of the disease, as the link between HIV and TB claims an ever-increasing number of lives.

Harvard TB researcher Carole Mitnick said that an estimated 500 000 new MDR-TB cases were reported globally every year.

"When they (patients) develop resistance to ... four drugs they become XDR which basically means there is hardly anything left to treat them (with)," said Dr Eric Goemaere, head of the Doctors Without Borders mission in Khayelitsha, Cape Town.

Resistance to TB drugs could develop when patients failed to take their medication as prescribed, or through direct transmission from person to person.

Promising new drugs
The Global Alliance for TB Drug Development announced that trials of two possible TB drugs were showing promise.

One of them, moxifloxacin, had the potential to shorten treatment time for drug-subsceptible TB from six to four months, or less.

This was undergoing phase three clinical trials.

The second drug, PA-824, being tested on TB patients in Cape Town, showed promise in treating drug-resistant TB.

The prolonged treatment time for TB has been cited as one of the reasons for patients abandoning treatment, which in turn leads to the development of drug-resistant strains of the disease. – (Health24, AFP, Sapa)

Read more:
Major new TB plan for SA
Tough TB quadruples in WCape

For more information on care and support of tuberculosis visit South African National TB Association (SANTA) or phone them on 011 454 0260.

November 2007, updated June 2010

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