Defaulters fuel TB pandemic

Despite the fact that effective tuberculosis (TB) drugs are available, the control of TB remains a major challenge in South Africa. The Free State is no exception with prevailing high treatment default rates.

Statistics have shown that the growing incidence of tuberculosis (TB) in the Free State is not due to a lack of sufficient health care, but due to the worrying trend of patients not sticking to their treatment regimen.

The Hit the Road and Walk for Humanity campaign recently visited Bloemfontein to emphasise the seriousness of this pandemic. It was led by global TB ambassador and television presenter Gerry Elsdon, who spread TB awareness messages through the streets of the city, focusing on taxi commuters and drivers.

“Unless everybody plays their role in stopping the spread of TB and ensuring that those infected get and complete their treatment regimen, TB will remain another pandemic despite the fact that it can be cured easily,” said Elsdon.
TB is the leading infectious killer of youths and adults in South Africa and it is estimated that it kills nearly 1 000 people every month. It is further estimated that 18 percent of TB patients in this country interrupt their treatment, which means that these people are exposing the communities in which the live to the disease.

“One of the problems we are battling with in the Free State is the default rate, meaning the amount of people who do not remain on their treatment for the entire duration of the medication.

“Many people enter the province seeking jobs. These individuals who come from other parts of the country and Lesotho are nomadic and transient, they move around a lot. And so we lose them and when we lose them, these defaulters are becoming a larger burden because if they had been on treatment, TB would not mutate in their body and turn into Multi-Drug-Resistant TB.”
Elsdon said transient patients need to inform their clinics about their movements so that they can be provided with referral letters.
Bloemfontein has the highest TB default rate of 12.4 percent.

Department of Health area manager Matlahile Kitsa said this high number can be blamed on nomadic people who do not notify their clinics and hospitals when they leave the province and also people who do not finish their treatment regimen.

“Due to movement of people and mushrooming of informal settlements, it makes it difficult to reduce the number of defaulters. However, we have gone back to basics. We have dedicated teams that help with the tracing of TB patients that interrupted their treatment, tracing, and screening of household TB contacts and assist with the community care treatment of drug-resistant TB patients that are discharged from the Multi-Drug-Resistant TB Units.

“The default rate numbers are not going up because Free State Health is failing. They are going up because of incidences of patients failing to stay and finishing their treatment.”

With cases of Multi-Drug-Resistant TB, the numbers are, fortunately, not as alarming. It is estimated that there are 7 098 TB patients, while 145 are suffering from MDR-TB.

However, the Free State clinical manager for MDR and XDR TB, Dr. Noor Zakhura, said despite the smaller number of MDR TB patients, it is very costly to treat them.

“Currently we have 145 MDR TB patients who cost the province R40 000 per patient only on medication, while TB costs R1 000 per patient. These amounts do not include hospital fees for your beds, food, nurses, and so on.”

The seriousness of the epidemic in this country was confirmed in June 1996 when WHO experts stated that South Africa has one of the worst recorded TB epidemics in the world.

TB is a highly contagious, but treatable lung disease that is spread when people who have it cough, sneeze, talk or spit the germs into the air.

According to the WHO, five to ten percent of people who are infected with TB become actively sick with it. The ordinary TB sufferer may infect 10 to 15 people each year if he or she remains untreated.
Motheo has the largest burden of TB patients in the Free State, followed by Lejweleputswa district, Thabo Mofutsanyana, Fezile Dabi and Xhariep.

“TB knows no barriers. It knows no colour, no religion and it certainly does not know whether you are in a facility or you are outside a facility. We advise TB sufferers to take care of themselves and protect their loved ones. Finish your treatment,” said Elsdon.

Meanwhile, researchers are conducting medical trials at the TB Research Centre in Thembisa east of Johannesburg to shorten the duration of tuberculosis treatment and thus make it easier for patients to complete the full regimen.

“Fighting tuberculosis is going to require new strategies. The ongoing trials aimed at reducing the treatment period from six to four months is one of the new strategies of fighting the disease,” said Gavin Churchyard, the chief executive of Aurum Institute, an independent medical research body.

“South Africa has the highest burden of TB infections (in the world), therefore it is important to position ourselves in the forefront of new research to help stop the disease.”

Aurum has partnered with the French pharmaceutical firm Sanofi to increase research capacity in various TB initiatives.

The chief executive of Sanofi, Christopher Viehbacher, said the long period of treatment has been identified as one of the reasons for poor adherence, resulting in drug resistant TB strains, which are more expensive to treat.