SA fighting losing battle against TB

by Ufrieda Ho and sapa

Tuberculosis is preventable and curable, but South Africa is still losing the battle against the disease.

South Africa now ranks fourth on the World Health Organisation (WHO)'s list of 22 high-burden countries. It's a slip of four positions this year and the country is unlikely to meet its TB millennium development goals, which is an accepted world guideline to halve the TB prevalence and death rated by 2015.

South Africa subscribes to WHO's Stop TB campaign, which chiefly advocates the Directly Observed Therapy System (Dots) as the effective monitoring and treatment regime to ensure patients don't default for the full six months it takes to complete TB treatment.

But the WHO 2008 report stresses that South Africa will need to focus on better early detection and treatment measures.

Government statistics for 2007 recorded 337 641 new cases of TB, but the Medical Research Council expects the figures for this year to come in at about 500 000 new cases.

More worrying is that as TB patients default on their treatment programmes, it causes drug resistant TB to rise.

Multi-drug resistant (MDR-TB) and Extremely Drug Resistant (XDR-TB) are now on the increase.

The 2004 statistics for MDR-TB was 3 278 last year but has risen to 7 369 cases. For XDR-TB it was 74 cases in 2004 and 536 cases last year.
"It costs about R400 to treat a TB patient over a six-month treatment programme, but when a patient becomes multi-drug resistant, it costs 10 times as much to treat; it takes longer and patients have to be isolated and it's even worse with XDR-TB cases," said Dr Zukiswa Pinini, of the Gauteng health department.

The need to isolate for effective treatment is not just emotionally traumatic, but also compromises patients' earning capacity and may take them away from running their households, which in turn has deep social impacts. Pinini acknowledged that TB is a "national crisis" that costs the country billions each year and will put even greater pressure on the public health system.

But turning the corner on this bacterial disease is stymied by high illiteracy rates, poverty and weak infrastructure especially in outlying regions, which stalls the crucial diagnosis and testing process.

But it is the high incidence of HIV/Aids that is highlighted as the crucial hurdle to overcome in tackling TB in the country.

"We know that TB is one of the deadliest opportunistic diseases for those with HIV," said Pinini, adding that not everyone who has TB has HIV or vice versa.

Government also only gives out antiretroviral (ARV) treatment to HIV patients who have a CD4 count of 200. This despite the fact that in the private sector, such as on the mines, the norm is to issue ARVs at a CD4 count of 350.

Dr Therese Maarschalk of De Beers, who attended a recent government-private sector workshop explained: "Because we know that TB is an opportunistic disease you want to keep your HIV/Aids patients' immune systems as strong as possible for as long as possible, which is why we give out ARVs before patients reach a stage where they're are already beginning to feel ill".

Meanwhile, a probe has been launched after tests showed levels of key ingredients in two TB drugs were too low, Health Minister Manto Tshabalala-Msimang said yesterday.

As a precautionary measure, her department had decided to withdraw all ANTIB-4 and EBSAR products that were four months and older, from circulation.

Supplier Pharmascript had agreed to provide replacement stock, she told a media briefing in Cape Town.

Though a test on stock that had been on the shelves for six months showed the ingredients were at the levels shown on the labels, another test, mimicking a longer storage period, showed at least two of the four ingredients in ANTIB-4 were below the label levels.

In the second test both of the EBSAR ingredients were below par.

"Confirmatory tests of the results are being conducted before action can be taken by the Medicines Control Council (MCC) with regard to the registration status of these two products."

Asked if she believed the supplier had been acting in bad faith, she said: "I think that is a question you should ask them, actually... We hope that try and serve the interests of those who are ill."