TB tests for health workers on cards as Motsoaledi goes into battle
Health minister says TB contact-tracing must include health workers who are at high risk of infection
All doctors and nurses could soon be subjected to annual tuberculosis tests as health minister Aaron Motsoaledi ups the ante on the rampant infection.
Speaking at the University of Cape Town, Motsoaledi said the long-awaited policy to protect health workers against TB could become a reality after the May 8 elections.
The policy, which has been in the pipeline for three years, is meant to address the fact that the TB infection rate of 21% among SA health workers is second only to China’s rate of 30%.
TB is the leading cause of death in SA and affects 60% of HIV-positive people.
Addressing UCT academics and students during a memorial lecture in honour of infectious disease specialist Stephen Lawn, who died of cancer in 2016, Motsoaledi said that despite SA being known as one of the most developed countries in Africa with advanced medicine, it was still crippled by TB.
He said the country would start screening every clinic patient in an effort to identify the 160,000 TB patients believed to be undiagnosed, untreated and infectious.
“We have undertaken to find at least half of these, or 80,000, by the end of next year. You can imagine the number that is still out there with TB, which is not followed up. That is why we emphasise that the health system must put more emphasis on primary health than it is doing today.”
The department had already started intensifying its TB contact-tracing programme, and between April and December 2018 it found 38,000 people who had TB but were undiagnosed, by following up on TB patients and screening their relatives.
Motsoaledi said TB contact-tracing must include health workers who were at high risk of infection.
“Perhaps the time has arrived that all health workers must be tested for TB … not screened, tested. By testing I mean lining up all the health workers and putting them through Gene-Xpert [a diagnostic machine] or X-rays. We must have health workers tested, maybe once a year, because many of them are vulnerable to TB.”
Health workers are not just getting normal TB infection but the severe strain and the difficult-to-treat drug-resistant MDR-TB.
“My heart breaks when I visit clinics, and I see many of them … the number of nurses who I can’t even look in the eye and see their level of bitterness,” said Motsoaledi.
“They don’t have an ordinary TB, but have MDR-TB, which they got from patients. The number of doctors who also get MDR-TB is alarming. We think that the time has come, and we believe that very soon we will be introducing that policy and health workers must be tested once a year.”
After the elections the policy document would be tabled before the National Health Council – the highest decision-making body on health policy.
The SA Medical Association welcomed Motsoaledi’s proposal but suggested it should apply to everyone who worked in clinics and hospitals, including cleaners and porters.
Association chairperson Angelique Coetzee cautioned that while testing health workers may be a noble idea, the capacity to do so could be a challenge.
“There are about 35,000 registered doctors in SA. That number on its own is huge,” she said.
“If all the nurses and other general staff must be tested and have their results within a reasonable time, we need to be very prepared and have enough people to carry out the task.
“We must also monitor over a certain period, maybe after five years, and see if testing health workers indeed reduces the impact of TB on healthcare workers.”
Helene-Mari van der Westhuizen, chairperson of the TB Proof Board, an advocacy organisation of healthcare workers with occupational TB, welcomed Motsoaledi’s pronouncement as a “unique opportunity for South Africa to take action and be a leader in addressing TB in health workers”.
She said: “We were struck by minister Motsoaledi’s heartfelt recognition that health workers face an unacceptable increased risk of TB and especially drug-resistant TB. Our hearts break with him for every colleague who becomes sick while caring for others.”
TB Proof was part of the national steering committee that developed the draft policy in 2016, Van der Westhuizen said: “Despite repeated calls by civil society to fast-track its release, we are still waiting for the final version two years later.
“We also welcome the commitment to test all health workers for TB at least once a year, and look forward to seeing which tests are proposed to optimise earlier detection of TB and prompt initiation of effective treatment.”
But she said the policy would succeed only if there was a comprehensive approach to preventing TB in healthcare settings, including improved infection control measures.
Motsoaledi said that even though TB remained the number one killer in SA, the latest research on morbidity and mortality showed the tide starting to turn.
According to the latest rapid mortality surveillance report by the Medical Research Council, released in 2017, infant mortality – which is driven mainly by TB and HIV infection – has declined from 39 per 1,000 births in 2009 to 23 in 2017. Under-five mortality declined from 56 to 32 while maternal mortality declined from 302 per 100,000 mothers to 134.
“While the stats are encouraging and show that we are beginning to turn the tide on these two epidemics, we are not out of the woods yet. These numbers are still too high for a country with the level of development such as SA,” Motsoaledi said.