SOUTH AFRICA: Drug resistance, alcohol and money

Photo: Julius Mwelu/IRIN

Treating drug-resistant TB can take up to 24 months

DURBAN, 4 June 2010 (PlusNews) - A complex mix of issues drives drug-resistant tuberculosis (TB) patients to default on medication, not least of which are alcohol and money, according to new research presented by Medicines Sans Frontiers (MSF), the international medical charity, at the South African TB Conference in the east-coast city of Durban.

When 22 percent of drug-resistant TB patients defaulted on treatment at one of MSF's clinics in the Cape Town township of Khayelitsha, despite access to services such as counselling and treatment support groups, TB councillors reviewed patient records to find out why.

Busisiwe Beko, a counsellor and former drug-resistant TB patient, found that household instability - often caused by a household member's alcohol abuse - circular migration to and from the neighbouring Eastern Cape Province, and financial pressures, were among the primary factors derailing treatment.

Treating drug-resistant TB - including multidrug-resistant TB (MDR-TB) and extremely drug-resistant TB (XDR-TB) - can take up to 24 months and comes with a battery of injections, pills, and adverse reactions that leave many unable to work, even when they are no longer infectious.

"They cannot return to work until their cultures are clear - we have this fear that they are using public transport [to get to work], so we are trying to minimise the chance of infections," Beko told IRIN/PlusNews.

Research presented by MSF's Yvonne Xhaso found that patients' inability to work made financial support crucial during this time. About 50 percent of drug-resistant TB patients have no form of income at diagnosis, and it can take as much as six months to obtain a public grant.

Patients wishing to access a monthly government disability grant of R1,080 (US$154.00) must submit various forms, including a physical examination by a doctor, a police affidavit, and a letter from a former employer.

Xhaso said there were often delays that extended this process for months, and she has recommended that the Department of Social Development streamline the process.

South Africa has the fifth highest TB incidence in the world, according to the World Health Organization, and the TB epidemic is fuelled by a high HIV prevalence rate of about 18 percent.

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