War on TB far from won

04 November 2013 - 02:03 By KIM CLOETE
Yogan Pillay
Yogan Pillay

South Africa is in a race against time to reduce its high rate of TB infections and deaths.

Yogan Pillay, head of the HIV, TB and mother-and-child programmes in the Department of Health says he is committed to reaching the Millennium Development Goal of bringing down the high tuberculosis mortality rate by the end of 2015.

"We need to look at interventions that will drive down the number of deaths from TB. We have to improve our TB cure rate to 85%. At the moment, it's still in the upper 70s - that's not good enough," he said at a conference on lung health in Paris at the weekend.

"We also need to double the cure rate for multidrug-resistant TB."

In its recently released Global Tuberculosis Report, the World Health Organisation said that South Africa was one of only a few countries in which the incidence of TB had increased in 2012. South Africa has one of the highest TB burdens in the world.

One of the problems is that many South Africans who have TB are not being treated.

Researchers at the Desmond Tutu TB Centre, at Stellenbosch University, are identifying the gaps in the health system that prevent more people from being diagnosed and treated for TB. These include poor registration of cases and slow access to treatment.

Pillay said the results of research by academics should be made easily and quickly available to the Department of Health.

"It must be quality, focused research that can be integrated into the work of physicians and nurses, and become part of their everyday work," he said

The Desmond Tutu centre shared its experience of doing what Pillay suggested. Its operations research assistance project connects doctors, nurses and other health professionals with researchers in all nine provinces.

Pren Naidoo, head of operational research for the centre, said its research in Western Cape showed that many children were not being diagnosed with TB. Children are in particular danger of contracting severe forms of TB, such as TB meningitis.

Naidoo suggested a more proactive way of getting patients to seek help at a clinic and comply with the prescribed treatment, including the use of SMSes to remind people of their appointments and to give them their test results.

"There is a need for a paradigm shift in the way we deal with patients. We need to empower them. We need to change our thinking dramatically. If we keep plugging on and doing the same thing, we are going to get the same result," Naidoo said.

The UN has said 3million people who developed TB last year were missed by national notification systems and did not receive the treatment they needed.

A combination of research, and working closely with people in hospitals and clinics, helped Cape Town improve its TB cure rate from 70% to 85% in the past few years.

Cape Town health sub-district manager Virgina de Azevedo told the Paris conference: "[Our] success is attributed to our chipping away at the problem from [many directions].

"It was many little things over time . like keeping patient records, getting the systems right and employing clerks to capture the data so that nurses could focus on the clinical care of patients.

"As a result, more people were diagnosed and treated for TB."