Better way of treating TB found

There are not enough hospital beds to treat patients with drug-resistant tuberculosis so doctors are treating those with the disease in their communities.

This has increased the number of people treated and reduces the cost of treating them - to such an extent that Health Minister Aaron Motsoaledi wants much more of it done.

Motsoaledi told the SA National TB Conference in Durban last week that the government would increase the number of "decentralisation" sites from 100 to 2500.

South Africa has the third- highest number of drug-resistant TB patients in the world and only has a cure rate of 40%.

The minister was responding to calls from Section 27 and the Treatment Action Campaign to declare drug-resistant TB a national emergency.

Under the new policy nurses will be trained in initiating treatment so that patients can stay in their homes.

Motsoaledi said that the number of clinics offering antiretroviral drugs was dramatically expanded to more about 3 000 in 2010 and the same would happen with TB treatment.

Western Cape has already adopted the decentralisation policy.

Doctors Without Borders initiated treating drug-resistant tuberculosis patients in Khayelitsha.

The doctors' organisation has been treating about 200 patients a year since 2010.

One decentralised site in Uitenhage, Eastern Cape, is treating 200 patients and has cured a child of drug-resistant TB while allowing him to go to school.

Treating people in their homes means that 95% of patients are started on treatment right away, as opposed to the national average of only 50% who wait at a clinic to be either diagnosed or to start treatment, said MSF doctor Jennifer Hughes.

UCT epidemiologist Dr Helen Cox said treating patients in the community cost R72103 over two years, compared to about R125000 over the same period for hospital stays.

The major benefit is that once TB patients are on treatment they are less infectious.

But patients do still need to visit a TB clinic periodically for check-ups and to get advice on further treatment.

At a decentralised TB treatment site in KwaZulu-Natal, the provincial department of health has speeded up starting times for patients waiting for treatment from 135 days in April 2011 to just seven days.

UCT professor Keertan Dheda called for hospices for patients with incurable tuberculosis.

Currently many terminal patients are discharged back into their community, where they can live for up to four years before dying - while remaining infectious.