Time to tackle DR-TB

Time to tackle DR-TB

“The greatest infectious killer in human history is making a comeback, morphing into new drug resistant forms. While it is largely forgotten in wealthy nations, millions of people a year get sick from
tuberculosis (TB).”

Journalist Jo Chandler shares this sobering reminder in an excellent article published in the The Global Mail on June 12, 2013 where she narrates her journey with TB – describing the devastation it is causing in Papua New Guinea, and her subsequent infection with multi-drug resistant (MDR) TB.

“(TB’s) DNA has evolved to remember and evade assaults from the pair of first-line, workhorse antibiotics that have worked so mightily to conquer TB in many parts of the world over decades – Isoniazid and Rifampicin. Until only a few years ago it was thought that only those existing TB patients who didn’t take their medicine – because they couldn’t access them, or because they refused or forgot them – were vulnerable to drug resistant strains. Now we know it spreads easily and invisibly in the air. My bug is a modern manifestation of an ancient plague that still has a few tricks up his sleeve,” Chandler writes.

Fast-forward a year and this NSP Review reveals how South Africa is battling to cope and beat this wily and resourceful pathogen.

While indicators show that the country is slowly turning the tide on HIV, TB continues to kill and disable adults and children despite being curable and preventable.

South Africa is now undoubtedly facing a devastating threat – MDR-TB. Experts such as Médecins Sans Frontières (MSF) brilliant activist specialist Dr Eric Goemaere believe this is only the tip of the iceberg. Already, high burden hospitals such as King George V are struggling to manage growing waiting lists due to improved diagnostic capabilities and battle to cope with the demand to treat a disease that requires intensive treatment with old drugs that are toxic and not always effective.

While the health department for years stubbornly refused to consider decentralising MDR-TB treatment to primary health care level, MSF had to again show the way reporting excellent results from Khayelitsha where they report high cure rates using community health workers as treatment supporters.

Provinces are slowly, but surely starting to rollout decentralisation, but the challenges are immense as patients are shunted around with catastrophic consequences for households that are mostly poor and far from treatment centres. Daily taxi trips to clinics for injections are unaffordable for most patients. If ever we wanted to live up to the motto of “taking health care to the people”, the threatening tsunami of drug-resistant TB could be the catalyst.

The Treatment Action Campaign (TAC) and SECTION27 believe that the national response to MDR and extensively drug resistant (XDR) TB remains woefully inadequate and insufficiently co-ordinated and monitored. We call for a high-level task team to be established urgently to devise a plan to halt these looming disasters.

The failure to manage and control TB in prisons is another area of grave concern. For example between March and June SECTION27 spent weeks struggling to help just one prisoner access the drugs he wants to take so he can get better. We receive such complaints on a regular basis and will publish a special edition of NSP Review focusing on prisons in early August. The NSP Review also appeals to the South African National AIDS Council (SANAC) to facilitate establishing a system that can receive and resolve the many complaints that come from prisoners and other vulnerable groups who are being denied treatment.

In this issue we turn the spotlight to the Gert Sibande National Health Insurance pilot district in Mpumalanga. NHI has been a pilot district for three years yet there is little evidence of improvement. What we found is concerning. The numbers tell us that almost half (46%) of all pregnant women who received antenatal care in state facilities in Gert Sibande were HIV- positive. This is disturbing.

The Treatment Action Campaign and SECTION27 on 13 November 2013 sent a letter to Kgalema Motlanthe, at the time deputy president of the country and chairperson of SANAC. The letter was also sent to the national health minister and then premier, and was a call for help, sharing details on the dire conditions of the health system.

Our stories from Page 44 are the voices of impoverished people who have no choice but to use this health system because their lives depend on it. It leaves you angry as their despair and desperation flows from the pages. This situation cannot continue and we appeal to the new SANAC chairperson and deputy president Cyril Ramaphosa as well as the health minster, premier and health MEC to urgently intervene to fix health services in this district.

We also publish a pullout centerfold with some of the most important NSP indicators and the available data. We look forward to future co-operation and engagement with SANAC on this and will be analysing and commenting on their report, which will be released in June.