Fighting TB

According to the World Health Organization (WHO), an estimated 440,000 multi-drug resistant tuberculosis (MDR-TB) infections occurred around the world in 2008 with a third of the patients dying. South Africa is fourth on the list of countries with the largest number of cases of multi-drug and extensively drug resistant tuberculosis. And nowhere is that more evident than in the KwaZulu-Natal Province, located in the far east of the country, where high levels of HIV/AIDS and poverty have led the number of tuberculosis cases to skyrocket.

The King George V Hospital in Durban, founded in 1939, has grown to become a world-leader in the treatment of TB. I've come here as part of a group of journalists invited by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria to look at the work being done by both government and non-governmental organizations to overcome the twin epidemics of HIV/AIDS and TB in South Africa.

Once inside the hospital, Sister Flora Nsubane helps me fit a surgical mask. I'm not usually germophobic but the idea that the only thing separating my lungs from some very serious bacteria is this thin piece of gauze is a little intimidating. Sister Flora has seen this before, and assures me it will protect me from becoming infected with multi-drug resistant tuberculosis, or MDR-TB.

We first head to the children’s ward, a spotlessly clean, but largely empty room because most of the children are at a school run for them by the hospital. A couple of toddlers are quietly playing on the floor. A baby girl in a highchair fixes her big dark eyes on the nurse feeding her pureed butternut, pureed chicken and mashed potatoes.

Sister Suminthra Sukmandam tells me the baby is four months old and was admitted to the hospital two weeks earlier with multi-drug resistant TB. Though her condition is the same, the nurse says her appetite is improving.

Sister Flora says the survival rate for children with MDR-TB is about 80 percent. This is because they are kept in the hospital for about a year where their treatment is closely supervised. The prognosis for adults is not as favorable, since they are admitted for six months and once their sputum is negative they are sent home to continue outpatient treatment.

According to Sister Flora, what all too often happens is that the patient will decide that they're tired of taking eight tablets a day and, instead of pushing them, their families will simply give in and say, "No, it’s okay. You can take it tomorrow." That leads to a vicious cycle of increased resistance and they take longer to be cured.

Two virulent forms of TB

Tuberculosis is an infectious bacterial disease which affects the lungs. It’s associated with poverty and spreads among people living in overcrowded, dirty places. It’s treatable with a six-month course of antibiotics but MDR-TB strains are increasing, because people don’t always take the prescribed drugs properly.

MDR-TB and the more severe form of XDR-TB don’t respond to the standard six-month treatment with first-line anti-TB drugs. It can take two or more years to treat these diseases with drugs that are less effective, more toxic and far more expensive than the first-line drugs used to treat ordinary tuberculosis.

Sister Flora leads us into a ward for men diagnosed with MDR and XDR-TB. Some of the 32 beds are empty. Sister Flora explains that the men are outside where they can benefit from the fresh air. We head toward a bed where an emaciated man is listlessly watching the people approaching. Jetro, who is 50 years old, tells us he was admitted two weeks ago with XDR-TB. He says about nine months ago, he was diagnosed as having ordinary TB and HIV.

“I am not sure why I got XDR because with the first TB, I followed the treatment correctly. But, now I am back in hospital, so I am not sure whether I will be cured or not," he says through a translator.

Over in the women’s ward we meet 36-year old Samkelisiwe, a single mother of a 17-year old boy. She says she took treatment for ordinary TB last year but on April 26 she was admitted to the hospital and diagnosed with XDR-TB

HIV and the TB epidemic

People living with HIV are at greater risk of developing tuberculosis because of their weakened immune system. WHO reports TB has tripled in the past 15 years in countries, such as South Africa, with high HIV prevalence. Sister Flora explains that at one time, TB and HIV were treated separately. But, now, she says all patients admitted to King George’s hospital are treated for HIV and drug resistance at the same time.

The World Health Organization warns MDR-TB threatens to become the dominant strain of TB over the next few decades, if there’s no significant investment into research and development of new drugs and vaccines.

Yet, relatively little money is channeled toward TB control and research. According to the Executive director of the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, Michel Kazatchkine, his organization provides about two-thirds of all international funding for tuberculosis. But, little money is available for multi-drug resistant TB.

"The Global Fund is basically the only funder of multi-drug resistant TB. And we are currently funding the treatment for about 30,000 people worldwide when there are an estimated 500,000 cases," he says.

Financial support for HIV/AIDS prevention and treatment is increasing. But, there’s no similar increase in funding for TB control and research despite the fact that TB kills nearly as many people as HIV/AIDS. Experts in the field of TB control believe this situation is not tenable.

Author: Lisa Schlein (mrm)
Editor: Stuart Tiffen