Call for TB treatment to be taken out of hospital
Report finds patients can be treated by collecting medication at clinics
IF YOU asked Goodman Makhanda of Khayelitsha about drug-resistant tuberculosis two years ago, he would have told you straight away – be extra careful of the disease if you are HIV-positive. “I never even paid attention to its cause. knew it as a disease that affected only those who are HIV-positive, so it didn’t bother me because I didn’t have HIV/Aids,” he recalls.
But 18 months ago the 32- year- old received the surprise of his life when he was diagnosed with multidrug-resistant (MDR) TB – a strain that later became a preXDR (extreme drug-resistant) TB.
“I coughed up blood at home one day and I knew something was wrong. I assumed that it must be pneumonia. I had to start treatment for MDR immediately. It was the scariest diagnosis because of my association of TB with HIV, so I assumed that I was HIV-positive… blame it on my ignorance. I lost 12kg within no time, had to take more than 20 tablets, and was on injectables five days a week for six months. It was hectic,” he said.
But as frightening as his prognosis was, Makhanda never had to set his foot in hospital and is doing well on treatment.
His success story is thanks to a decentralisation of care programme, offered by Médecins Sans Frontières (MSF) in collaboration with the provincial Department of Health and City of Cape Town. The programme, piloted in Khayelitsha since 2007, is aimed at treating MDR and XDR TB patients at primary health care level instead of admitting them to hospital. Patients get their medication from clinics instead of hospitals, and after they complete injectables and adhere to treatment they can get medication outside the clinic.
Prior to 2011 the national policy mandated hospitalisation of all drug-resistant TB patients for treatment initiation – a process which resulted in long delays, high rates of transmission and mortality.
According to the report which is being released today to coincide with World TB Day, over 90 percent of diagnosed patients’ cases in that township have been initiated on treatment, an improvement compared to other areas in the country where the rate is estimated at about 50 percent.
Dr Jennifer Hughes, a TB specialist with MSF, said the latest report showed that a more tolerable, cheaper, shorter and effective TB treatment was needed.
“Currently a lot of these patients have to give up their lives such as jobs and family life as they are kept in hospitals for treatment. In this report we show that the health care system doesn’t have to interfere in people’s family lives as it is doing currently. Rather we should take health care to the people and treat resistant TB without isolating them from their communities,” she said.