Massive push to stop the spread of Tuberculosis in the Eastern Cape
The Eastern Cape department of health has implemented a TB Recovery Plan, as advised by the national department of Health (NDoH), which is aimed at ensuring people who have defaulted on their treatment or are yet to start, or have not yet been diagnosed, are identified and helped.
The theme for 2023’s World TB Day commemoration is “Yes! You and I Can End TB”.
The commemoration is designed to increase public awareness about TB and its impact.
It is an opportunity to accelerate efforts to end the TB epidemic globally.
The theme emphasises that “your health is in your hands”, therefore play your role to save your life.
It encourages everyone to be accountable and contribute towards the fight against TB.
Representatives from the provincial department of health will gather at Mgwenyane location in Nyandeni local municipality, in the OR Tambo district, on Thursday to commemorate World TB Day.
The year 2023 has been declared the “The Year of the TB Client”.
The TB Recovery Plan’s (TRP) focus includes undiagnosed people, diagnosed patients who have not started treatment, and those who started but have defaulted on their treatment.
The plan was initiated in September 2022 in the Eastern Cape after an orientation conducted by the national department. “All these categories of people continue to spread TB and also are at risk of contracting a resistant strain of TB or dying, yet this could be prevented.
“The second component of TRP is strengthening systems for linkage to care.
“This ensures all people diagnosed with TB are started on treatment as soon as possible to prevent the spread of TB,” health MEC Nomakhosazana Meth said.
“The third element the TRP focuses on is strengthening systems to ensure all TB patients started on treatment are retained for care until they finish the treatment course and are successfully treated.
“Lastly, the TRP emphasises TB Prevention. This includes scaling up implementation of 3HP [therapy to prevent TB in high risk group] and the expansion of TB Prophylaxis Therapy to household contacts and strengthening Infection Prevention and Control in health facilities.
“Also, the National Strategic Plan for HIV/Aids, STIS and TB [2017-2022] is aligned with the World Health Organisation’s End TB Strategy in emphasising prevention, detection, and treatment of TB,” Meth said.
She said the country had made significant progress in the control of TB.
“Many strategies to fight the scourge of TB and improve treatment outcomes are implemented, including improving resources and developing new guidelines.
“For example, the introduction of the nine-month regimen to treat resistant TB, new paediatric formulation, new diagnostic technology like the introduction of Genexpert Ultra, 90-90-90 strategy and 3HP and LF LAM,” the MEC said.
The department of health devised the TRP after identifying challenges during the Covid-19 pandemic in 2020 and 2021, due to the difficulty in accessing health facilities because of the lockdown regulations.
During the pandemic, the TB mortality (worldwide) rate increased for the first time since 2005, with 1.5-million deaths recorded in 2020 and 1.4million in 2019.
Identifying undiagnosed people with TB by using a TB health check — a tool to conduct self-screening in communities — was initiated.
“People were and are still encouraged to use WhatsApp number 0600123-456 or dial *134*832*5# to screen themselves and go to the clinic for testing if they meet the criteria for testing.
“Also, the key populations [People Living with HIV, household contacts and previously treated TB patients] are now tested for TB irrespective of whether they have symptoms of TB or not.
“Screening using LAM assay, which is a urine test, for rapid diagnosis of TB in HIV positive people with low CD4 cell counts and are very sick.
“This test was initially done in hospitals, but now it is rolled out to the community health centres. Digital Chest X-rays are implemented in partnership with developing partners.
“Ever since implementation of these initiatives, more people are screened and diagnosed for TB.
“These are the people that could have been missed if LAM, the TB health check and digital chest X-rays were not being implemented,” Meth said.
She said strengthening systems for linkage to care had also led to patients being able to receive their TB results via SMS.
“This initiative shortens the duration of the patients receiving the TB tests via the health facility [clinic or hospital], as the laboratory staff, once the test is finalised, sends the results to patients’ phones, if [their contact number] was provided.
“On receiving the results, the patients go to the clinic for treatment initiation,” Meth said.
Strengthening systems for retention in care was vital, said the MEC.
“The patients started on treatment are educated on TB and adherence counselling provided.
“To ensure adherence to treatment, multi-drug resistant TB [MDR-TB] is shortened from 18 months to nine months, and six months is on pipeline.
“Ever since the short regimen was started, the success rate has increased as compared to the long regimen.”
TB Preventive Treatment has also been scaled up with 3HP, piloted in the OR Tambo district, and is being rolled out to other districts.
The decentralising of MDR-TB care, which is a community model, allows newly diagnosed MDR patients to be started on treatment in the sub districts they are based in.
“Initially, the MDR-TB patients were started on treatment in either Jose Pearson in Gqeberha or in Nkqubela in Mdantsane, however, now each sub district has its own decentralised site, which is managed by the trained staff.
“The service has come closer to the patients and the duration between diagnosis and initiation is shortened,” Meth said.
The department has empowered and supported its healthcare workers by conducting training, in partnership with the national department and non-governmental organisations, to keep staff up to date with new prescripts and to ensure that already existing guidelines are adhered to.
Managers continue to mentor staff at the facilities to facilitate the prompt implementation of new guidelines.
The department has also conducted public dialogues to ascertain how relevant stakeholders feel about the services rendered and what needs to be done to improve on these.
“Educational talks are conducted through national radio and community radio stations to inform and advise the communities and to increase knowledge on TB and HIV.
“Despite the interventions in place, the department is still facing a challenge of high loss to follow up, which attributes to the use of wrong addresses, and a poor referral system.
“The department has engaged relevant stakeholders to address this challenge.
“Some patients face stigma and discrimination, which are barriers to access to treatment and result in poor adherence.
“The barriers to access cannot be addressed by the department only, and requires a collective effort by relevant stakeholders, including community structures, families, and in the workplace,” Meth said.
Despite the high prevalence of TB among adults, fewer children were diagnosed.
“Usually, the source of TB in children is the adult, therefore if an adult TB patient is staying with children, extensive contact tracing should be done, and the children must be tested for TB, and if diagnosed, they should be started on treatment.
“For the children to comply and adhere to treatment, the parent or guardian is provided with information on the importance of completing treatment to prevent resistance or death.
“If no TB is detected, the children are then put on TB preventive therapy to prevent them from contracting TB,” the MEC said.
Meth said TB was preventable and curable and that people should take responsibility and get tested.
The test is quick, easy and free.
“If a TB test is positive, the person will be started on treatment as soon as possible.
“It is essential to complete treatment [full six months], even if feeling better, to prevent MDR-TB, which is very expensive to treat and takes longer than six months.
“People must know that TB is curable even if one is HIV positive, therefore, the department encourages people living with HIV to be screened regularly for TB.
“To end TB, people must also know their HIV status. If positive, start ART and adhere to treatment.
“TB Preventative therapy will be given to prevent TB disease.
“Play your part; treasure your health.”
To minimise the spread of TB, people are encouraged to always cover their mouth when coughing or sneezing, to wash their hands with soap and water, or sanitise, and to practice a healthy lifestyle (eat a nutritious diet, exercise, and avoid smoking or consuming alcohol).
One person with TB can infect up to 15 people, and without treatment, those people may die.
Access to treatment is a right, exercise it.