Despite an increase in diagnosis times, South
Africa is facing a growing drug-resistant tuberculosis (TB) burden as
nationally there remains a large gap between the number of patients diagnosed
with multidrug-resistant TB (MDR-TB) and those who start treatment.
Between 2007 and 2012, recorded cases
of MDR-TB, which is resistant to at least two of the primary drugs used to
combat standard TB, almost doubled.
South Africa has improved its ability
to test for drug-resistant TB by introducing GeneXpert, a rapid testing machine
that can diagnose TB in sputum samples in less than two hours.3
But in 2012, just 42 percent of
patients diagnosed with MDR-TB began treatment, according to government
figures. The success rate for those on treatment is about 40 percent.
"If we don't do something about
it now, MDR-TB is going to become XDR-TB ," Dr. Jennifer Hughes, a
drug-resistant TB doctor with Médecins Sans Frontières (MSF), told IPS.
XDR-TB is a strain of TB resistant to at least four of the main TB drugs.
"If we don't start focusing on
how we treat XDR-TB properly as well, we're just going to drive further and
further resistance as we go."
Treatment Gap
Most of South Africa's provinces have
increased their treatment capacity for MDR-TB patients after the government
introduced a 2011 framework for decentralising MDR-TB care. This allows
patients to start treatment at sites closer to their homes instead of the
country's few specialised TB hospitals, where a typical stay is six months.
But provision of treatment at primary
healthcare level needs to increase, Dr. Norbert Ndjeke, director of the
Department of Health's DR-TB, TB and HIV division, told IPS.
" is not moving at the speed we
want it to," admitted Ndjeke. There is no special budget for
decentralisation and provincial governments choose how to prioritise their
spending, he said.
The number of sites MDR-TB patients
can start treatment in the Western Cape, Gauteng, Eastern Cape, and the Free
State provinces has quadrupled due to decentralisation. The number of sites in
the Western Cape, for instance, went from four to 17, while Gauteng now has
five treatment sites instead of one.
Limpopo Province has not added new
facilities, while North West and the Northern Cape provinces have doubled
available treatment initiation sites, going from one to two, and two to four,
respectively.
When properly implemented,
decentralisation can cut the treatment gap.
In Khayelitsha, a large semi-informal
township on the fringes of Cape Town, a combination of quicker testing and
decentralisation has led to the time between diagnosis and treatment for
drug-resistant TB dropping from 73 days to just seven days between 2007 and
2013, according to data by MSF. Ninety-one percent of patients diagnosed with
MDR-TB in Khayelitsha in 2013 began treatment.
Ndjeke noted that provisional national
data for 2013 indicates that 10,095 MDR-TB patients began treatment. Figures
are not yet available for the number of patients diagnosed during that period,
but in the first nine months of the year 7,271 patients were diagnosed with
MDR-TB, possibly indicating a shrinking gap between treatment and diagnosis.
Accurate recording and reporting of
patient numbers and outcomes remains a challenge, and the government is working
to improve its systems, he said.
Large Burden
South Africa has the world's
third-largest TB burden, after India and China, according to the World Health Organisation. It also reports
the world's most cases of XDR-TB, a virulent form of the disease that is
resistant to at least four of the main TB drugs and has a treatment success
rate of less than 20 percent. An estimated one percent of the population of
about 51 million develops TB every year.
"We have in South Africa one of
the only rising epidemics of drug-sensitive TB and drug-resistant TB. And we
are not doing very well at detecting it and treating it," said Gilles van
Cutsem, MSF's medical coordinator for South Africa and Lesotho, at a media
briefing.
Doctors are concerned about the rise
in transmission of drug-resistant TB.
When drug-resistant TB started
emerging it was mainly due to patients not being able to complete their full course
of treatment for standard TB, said MSF's Hughes. But now most drug-resistant TB
transmission happens through people breathing it in from others, she said.
New Drugs Offer Hope
One of the main challenges for
treating drug-resistant TB is that the available drugs come with side effects
including nausea, vomiting and permanent deafness, which often deters patients
from finishing their treatment course.
"The drugs are horrendous – it's
a terrible regime but it's the best they've got," Hughes told IPS. On
average, patients need to take between 12 and 15 tablets daily for two years,
she explained.
South Africa is running a clinical
access programme for up to 200 XDR-TB - and pre-XDR-TB patients with
limited treatment options for a new drug called Bedaquiline, the first drug
designed specifically to treat TB in over 50 years.
One of the features of the drug, which
is taken along with other drugs, is that patients get better a lot quicker,
said Dr. Francesca Conradie, clinical advisor to Sizwe Hospital, a MDR-TB
hospital in Gauteng.
"It's the first in a pipeline of
maybe four or five drugs that will revolutionise the way we treat MDR-TB,"
said Conradie.
Based on the outcomes of this initial
programme, South Africa's Medicines Control Council will decide whether or not
to register Bedaquiline for use for more patients.
A new regime of drugs for
drug-resistant TB patients could be ready by 2022 based on the outcomes of
existing trials, said van Cutsem.
No comments:
Post a Comment