We’re fighting the TB battle in the wrong way with the wrong weapons
SA lags behind WHO guidelines, causing a huge gap in treatment which sends infection spiralling out of control
Outdated guidelines for treating tuberculosis risk reversing the gains SA has made against the killer disease.
That is the view of TB researchers, health workers and activists who gathered in Cape Town this week to mark World TB Day, which was on Sunday.
At a gathering convened by the NGO Section 27, the experts said SA was lagging behind new World Health Organisation guidelines from 2018 which say anyone at high risk of TB infection should take prophylaxis.
SA offers this treatment only to TB contacts under the age of five and those who are HIV-positive.
This gap in treatment not only resulted in family members and colleagues of TB patients developing active TB, said the experts, but sent infection spiralling out of control because the disease spread before active TB was diagnosed.
Desmond Tutu HIV Foundation CEO Prof Robin Wood, whose research interest is TB diagnostics and transmission, said SA was facing a TB crisis, even among young people.
In Masiphumelele, the Cape Town township where he conducts research, 20% of children had TB infection by the time they went to crèche.
Wood said SA brought TB under control between the late 1950s and 1980s, largely thanks to mobile X-ray units that identified infected people who were not necessarily sick. But this strategy was scrapped when the WHO said it was not cost effective – based on an analysis of the number of cases uncovered.
Wood said the better measure would have been the number of cases prevented. “We always follow this data from the West, which I find a little bit depressing,” he said.
“We are the worst-burdened country in the world. We are facing a major crisis, which we have been facing for a long time. We need to start thinking for ourselves and talk about taking treatment to the communities. The last time we did that we brought TB under control.”
Arne von Delft, who launched the activist organisation TBProof in 2012, said even though he was a doctor and contracted the disease from his doctor wife, Dalene, neither he nor his wife’s colleagues were offered screening.
Newborns exposed to his wife in a neonatal unit before her diagnosis in 2010 were also not offered screening.
Von Delft, who was treated for presumed pleural MDR-TB infection two months after his wife fell ill, gave up on prophylaxis six weeks after he started taking it because it damaged his tendons so badly that he was unable to walk.
“Because I had pleural TB, I had a 50% chance of reactivation. I hate the idea that I could become sick any time and expose those I love to TB, including two young children,” he said.
“As a doctor, eight years later I still can’t do anything about it. The drug I was using as a prophylaxis had four ‘black box’ warnings from the [US] Federal Drug Administration for various high-risk side-effects. Despite all of that it is considered the safest prophylaxis for MDR-TB patients. We really need much better options.”
Activists said that if SA adopted a “test-and-treat” approach for TB similar to its HIV strategy, the epidemic would look different. The “vicious neverending cycle of transmission” could be brought under control, said Von Delft.
Ivy Apolisi, a nurse from Doctors Without Borders who works in Khayelitsha, said another overlooked area in the TB guidelines was substance abuse, because drug users were most likely to default on TB treatment.
“There is also no doubt that children and adolescents who had contact with TB patients require special attention,” she said.
As a health worker in Khayelitsha, she said many TB patients were lost to follow-up because they didn’t have permanent addresses.
The department of health failed to respond to questions sent to it.
Tuberculosis in numbers About 322,000 South Africans became infected in 2017, according to the 2018 WHO Global TB Report;
Less than three quarters of people diagnosed with TB in 2016 were started on TB treatment, according to the District Health Barometer 2016-17;
SA had about 14,000 cases of multidrug-resistant TB in 2017;
Roughly 78,000 South Africans died of TB in 2017. Of these, 56,000 were HIV positive.