SOUTH AFRICA: Turning the tide against drug-resistant TB
Photo: Dominic Chavez/WHO  | | People living with HIV are particularly susceptible to drug-resistant TB |
UMSINGA, 9 October 2009 (PlusNews) - Three years ago, the Church of Scotland Hospital at Tugela Ferry, in the rural Umsinga area of South Africa's KwaZulu-Natal Province, was the focus of international media attention as the epicentre of a deadly outbreak of extremely drug-resistant tuberculosis (XDR-TB).
It was reported that 52 of the 53 patients initially diagnosed died within a month of contracting this strain of TB, which is resistant to both of the first-line antibiotics used to treat the disease, as well as two classes of second-line drugs. People living with HIV are particularly susceptible to TB and most of the XDR-TB patients at Tugela Ferry were co-infected with the virus.
The attention may have come as a blessing in disguise. Today the hospital is internationally recognized for its handling of TB cases, including multidrug-resistant (MDR-TB) and XDR strains. Some of its doctors have presented their insights on how best to deal with this spreading epidemic at international conferences.
After the crisis, international aid poured in from the Stop TB initiative run by the World Health Organization, Yale University, and various NGOs. South Africa's Department of Health also began prioritizing the area.
The government sent more than 100 tracing and tracking teams of specialist doctors, nurses, pharmacists and community health workers to comb Umsinga and the surrounding areas, looking for new TB cases and patients who had defaulted on their treatment.
The epidemic of drug-resistant TB has been largely attributed to patients failing to complete their six-month course of first-line TB treatment, and a failure to follow up on defaulters.
Now, an individual who defaults on his medicine is considered not only to be endangering his own life, but also that of his whole community, as the drug-resistant strains of the airborne disease are easily spread.
A member of the tracking and tracing team, who gave his name only as Themba, told IRIN/PlusNews that before their arrival large numbers of people had defaulted on their TB treatment. "Now, all that is gone and almost every patient in the community is taking their drugs."
The hospital gives Themba's team lists of TB treatment defaulters to track down and bring in for monitoring in an isolation ward. Those with ordinary TB are treated in separate wards; those with MDR-TB are sent to the nearby Estcourt Hospital, which has a dedicated section for such cases. Patients with XDR-TB are sent to King George Hospital in the coastal city of Durban, where all cases in the province are treated.
The tracing teams also track down family members of patients diagnosed with MDR-TB or XDR-TB. When local resident Balungile Ngubane's brother, Sipho, was found to be suffering from XDR-TB in 2007, she and her family were rounded up and taken to the local clinic, where they were kept in isolation for a week until the results of sputum tests showed they were free of the disease.
Unfortunately, her brother died a few months later. "I think they did the right thing," she said. "We loved our brother, but he could have infected us all before he died."
Thembitshe Mabaso, a local chief, commended the work done by health professionals and workers, who have trained local communities to identify people with TB symptoms and support them in completing their treatment.
"We call them when we see that there is a person who suffers from symptoms of deadly TB, and they come along and take that person to the hospital and conduct tests," he told IRIN/PlusNews. "Most of the time we found that our suspicions were accurate, and then the whole family is screened to see whether they have been infected due to contact with that patient."
At the peak of the epidemic in 2006, Umsinga was contributing more than two-thirds of the XDR-TB and MDR-TB cases in the province, but Dr Tony Moll, Principal Medical Officer at the Church of Scotland Hospital, is credited with leading the efforts to turn the tide against the deadly new TB strains.
Since then, 488 cases of XDR-TB and 356 cases of MDR-TB have been diagnosed. "The TB prevalence rate is still very high in the area," Moll told IRIN/PlusNews. "We get about 150 new TB cases every month."
Dr Lindiwe Mvusi, head of the national health department's TB unit, said the Church of Scotland Hospital and the district as a whole had been very successful in identifying potential TB cases, diagnosing patients, and quickly putting them on treatment. The hospital achieved a TB cure rate of 83 percent in 2008, compared to the national cure rate of about 60 percent.
"They have handled it well; they have managed to have a high cure rate and prevented people who have these strains from spreading [them] to other members of the community," she said. Other health facilities in the region would "have to use the same principle, so that we can win this war".
In 2008 South Africa recorded 576 new cases of XDR-TB, 6,219 new cases of MDR-TB, and 388,802 cases of ordinary TB. "The numbers are still rising," Mvusi said, "but as we implement new measures, we hope that by 2015 these figures would start to come down."
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