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2008 SERIES

EPISODE 10 - MDR and XDR TB

The TeamAdolescents & ARVsHerpes & HIVCelebrities & HIVSero-disordant coupleRelationships & sex Breast, bottle or cup?VCTHate crimesMDR & XDR TBCircumcisionGender violenceInfants on ARVsSexual negotiationsSocial grantsCervical cancerSubstance abusePMTCTFarm workers & HIVPEPTeen pregnancyDisclosureNSPStigma and predjudiceWater and sanitationHuman rights

 

 

How three letters, HIV, can lead to two more, TB.

Tuberculosis is a devastating disease. As South Africa has the second highest incidence of TB in the world, it is vitally important that we are all exposed to the reality of this disease. As HIV positive people are even more susceptible to becoming infected with TB, educating the public on how to treat this disease properly becomes even more urgent.

This week's episode of Siyayinqoba Beat It! explores the relationship between TB (Tuberculosis) and HIV in South Africa. Due to immunodeficiency, the chances of catching TB are considerably higher if the patient is already HIV positive. HIV also alters the clinical course of TB, making it difficult to diagnose. The rapid spread of the disease often makes it fatal.

One of the major points discussed is the fact that South Africans generally default from the six month DOTS (Directly Observed Therapy, Short Course) regimen. Although this treatment has proved immensely successful, South Africa only has a 60% success rate.

Siyayinqoba Beat It! examines how TB affects people's lives at various stages of diagnosis and treatment. Our first guest is a doctor from the Jose Pearson TB Hospital in Port Elizabeth, who explains the dangers of drug-resistant TB and the threat it poses to society.

Read the transcript of our interview with Dr Lujabe here

In a controversial segment, our Community Journalists examine the human rights ramifications of quarantining patients affected with this deadly disease. Is it a human right violation to isolate patients? Or is it in the greater public's interests? Siyayinqoba Beat It! visits a patient in quarantine and examine a case where the courts ruled that some patients be sent back to quarantine, even after they had attempted to escape, due to the danger this disease poses to society.

Download the transcript detailing the challenges of infection control

The price of confinement

TB Patients "Break out"

Doctor

 

TB infection control

 

IT'S A FACT
South Africa faces a TB epidemic which is linked to the HIV epidemic. About 453000 new cases of TB were reported in 2006.
Poor drug adherence (not finishing your TB drugs) poverty and HIV have contributed to Multi-Drug Resistant TB (MDR TB).
MDR is defined as TB that is resistant to two of the most common drugs, Isoniazid and Rifampin. XDR (Extreme-Drug Resistant) is resistant to those drugs, as well as to three of the second line drugs.
MDR TB can still be treated using the second line antibiotics that are available.
XDR TB, which has very high fatality, emerged as a problem in 2006.
It costs R377 to treat an ordinary TB patient for six months. MDR TB treatment can cost R31 000 for six months of treatment. XDR TB treatment is even more expensive, and usually fatal.
Healthy people can be infected with MDR and XDR TB in the same way that ordinary TB would infect them: airborne transmission through sneezing, saliva, etc.
While ordinary TB can be cured in six months, MDR TB can take up to two years with many more side effects.
After two weeks on treatment, a person with ordinary TB is no longer infectious and normal life can resume.
Because MDR and XDR strains of TB remain infectious for a long time, it raises a difficult human rights issue: the need for isolation for the patients and the difficulties of treating patients in the community.
Many patients, especially people living with HIV, can acquire TB and even MDR or XDR TB through the hospital system where these patients are gathering.
There needs to be an urgent improvement in infection control in hospitals. This includes:

-more rapid screening of MDR and XDR TB

-the separation of MDR and XDR patients from ordinary TB patients in hospitals

-improved ventilation and consistent use of protective masks for health care workers

-more consistent roll-out of available preventive treatments that can provide significant prevention against contracting TB for health workers.
MDR and XDR patients require extensive hospitalisation and need to be given social grant support for their families. Currently grants are stopped for people who are hospitalised. This is a major reason why patients resist hospitalisation.
Conditions in hospital, including opportunities for productive work for patients to prevent unbearable boredom, need to be greatly improved.
Of about 44 million people living with HIV world wide, 12 million also have TB. 66% of these are in Sub-Saharan Africa.

Mass public education on infection control needs to be improved.
People living with HIV are much more vulnerable to TB.