South Africa: TB testing expands

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South Africa is to expand its rollout of GeneXpert tuberculosis (TB) testing machines, which can diagnose TB and drug-resistant TB within 90 minutes, but concerns remain about backing up this commitment with supplies and treatment.

TB

The country is the largest buyer of GeneXpert technology in the world, but the machines have not yet become point-of-care tests and are often deployed at district rather than clinic level. Nonetheless, they have shaved weeks off waiting times for patients because samples no longer have to be transported to and from national referral hospitals miles away for diagnosis, according to the UN humanitarian and news analysis service, IRIN.

At the opening of the TB Vaccines Third Global Forum in Cape Town on  March 25th, Precious Matsoso, director general of the South African Department of Health, announced that an additional 135 machines, to add to the existing 150 South Africa has, would  be imported by the end of 2013.

Matsoso also announced that the health department, the National Department of Science and Technology, and the US-based non-profit TB vaccine developer, Aeras, would continue to fund the recently created South Africa Consortium on TB Vaccines.

The World Health Organization (WHO) lists South Africa in the top 22 countries with a high TB burden. An estimated 500,000 cases of active TB are diagnosed annually and the disease remains the leading cause of natural death according to the national statistical service, StatSa. It is a highly infectious airborne disease that thrives in a weakened immune system and, given South Africa’s already high rate of HIV, people are extremely susceptible to infection.

In a joint letter delivered to South African Minister of Health Dr Aaron Motsoaledi in March, the South African AIDS lobby the Treatment Action Campaign (TAC) and international medical humanitarian organization Médecins Sans Frontières (MSF) stressed that the success of the GeneXpert rollout hinged on a steady supply of testing cartridges for the machines, the decentralization of drug-resistant TB (DR-TB) care and treatment, and improved supply-chain management to avoid recurring drug stockouts.

The organizations also questioned the continued delay in implementing the Health department’s 2011 policy decision to move DR-TB care out of designated TB hospitals with a shortage of beds to primary healthcare clinics closer to patients’ homes.

“Provincial operational plans for decentralization of multidrug-resistant TB (MDR-TB) care have not been drafted, nor have readiness assessments been conducted of all proposed decentralized MDR-TB (sites),” the letter pointed out. The organizations urged the health department to implement the 2011 policy, which would allow all of South Africa’s nine provinces to begin initiating and managing stable adult and paediatric MDR-TB at local clinics before the end of 2013.

Lack of Awareness

TB is of course treatable, but a lack of awareness at the community level combined with challenges to completing treatment, has seen the disease spread rapidly. More worryingly, in South Africa the development of a strain resistant to drugs has emerged.

South African Red Cross Society branches in the Eastern Cape provide care and support to TB patients in what is one of the poorest regions in the country. “The community is aware of TB, but they lack knowledge on how to protect themselves from getting it, spreading it and managing their treatment,” says Ruth Mufalali, South African Red Cross Society TB project manager.

Putting stickers in local minibuses has been one activity in a month-long TB awareness campaign run by the organization across the Eastern Cape. Minibuses provide perfect conditions for TB to spread; if one person has it, then the other 14 people in the minibus are all at risk. “People tend to close windows in minibuses, stopping air from circulating. As TB is an airborne disease, it is very important to allow air circulation,” says Mufalali.

In rural areas where access is a barrier to receiving treatment, Mufalali and her team visit communities where people have to walk up to 50km to reach the nearest clinic to educate them about TB symptoms and the importance of early and continued treatment.

Mufalali says while their campaign created awareness, dialogue and focus on TB through simple activities, long-term work is needed across all areas of society to reduce and eventually stop the spread of TB.

“It’s frustrating to watch people die from TB. People need to know simple ways to prevent it and to keep from spreading it. It’s just so devastating because it is preventable.”

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