TB is still a major headache

With World Tuberculosis Day celebrated on Saturday 24 March, council is hopeful that advances in the treatment of the disease will help more patients stay on course and convince others to seek appropriate care.

In a statement released last week, the City of Cape Town said TB has a “destructive impact” on the health of communities. “According to the World Health Organisation, TB is the ninth leading cause of death worldwide despite the fact that it is both preventable and curable,” said JP Smith, Mayoral Committee member for Safety and Security; and Social Services.

“In Cape Town there has been a decrease of nearly 24% in the number of reported TB cases in the last eight years, from 29 726 in 2010 to 22 681 in 2017. While this is good news, this incidence is still at an alarmingly high level.”

He further said a new drug was introduced for the treatment of drug-resistant TB in 2015, while a shorter treatment regimen of nine to 12 months was introduced in October last year. “It is encouraging to note that patients receiving the new medication are responding to treatment better and have improved their treatment outcomes,” Smith noted.

“It is hoped that the shorter treatment duration means more patients on drug-resistant TB treatment will complete their treatment.”

City health staffers have embarked on an active surveillance programme to systematically screen all adults seeking healthcare at council facilities for TB to identify undiagnosed cases and activate testing and treatment, he added.

“The diagnosis of TB is reliant on persons with symptoms presenting themselves at healthcare facilities. Many people with active TB are asymptomatic in the early stages, are unlikely to seek care early and may not be properly diagnosed when seeking healthcare,” Smith said.

“People with undiagnosed, untreated, and potentially infectious TB are frequently seen in health facilities. One person with infectious TB can infect another 10 to 15 people.”

Clients with undiagnosed infectious TB pose a risk of transmission in health facilities and communities. Smith said for healthcare workers, the challenge is to get undiagnosed patients tested and treated as soon as possible. Symptoms that could indicate TB include a persistent cough for more than two weeks, unintended weight loss of more than 1,5 kg in a month, an ongoing fever or drenching night sweats.

“Furthermore, if someone has had contact with someone with TB or has had TB before and develops any of these symptoms, they should immediately report to a health facility for TB testing. People who have had a TB test done at a health facility need to return later to receive the test results,” Smith explained.

“Another challenge is that one out of every 10 clients started on TB treatment does not complete the full six months of treatment for drug-sensitive TB. Even more are not completing their full course of drug-resistant TB treatment, which is longer and needs different drugs to those used for drug-sensitive TB.”

Adherence is difficult due to the long duration of treatment, but there has been recent progress in addressing these challenges. “As with most health challenges, this is a shared responsibility. I encourage the public to openly engage with health matters that affect them and to support those living with the disease,” Smith implored.

“Caregivers are encouraged to bring all children younger than five to their nearest clinic to be screened if they are in close contact with an adult with TB. Healthy children will receive preventative medication, while children who are unwell will be started on TB treatment if needed.

“Stigma remains one of the biggest stumbling blocks to patients accessing lifesaving treatment, but it does not have to be that way.”

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