TB and MDR-TB

Over recent years there has been an alarming increase in drug resistant strains of tuberculosis (TB) in South Africa.  Multi-drug resistant, or MDR TB and XDR TB, are much more difficult to treat and diagnose than the ordinary TB strain. This week the Siyayinqoba Beat It! CJs visit a young woman to find out what it is like to take treatment for HIV and MDR-TB at the same time. We also speak to doctors in KZN and the Western Cape to find out how TB is currently tested and treated and what possibilities there are for improving testing and treatment in the future.

Sandra Dlamini from Mtubatuba in KZN has been living with HIV for 15 years and also had MDR TB. She was taking ordinary TB treatment but when she noticed it was not working she tested again and was diagnosed with MDR-TB. At King George Hospital, Dr Iqbal Master, explains that when the two key drugs used to treat TB (INH and Rifampicin) are not working, second line drugs are needed. These however are not as strong, meaning they take longer to work, require the patient to take injections for long periods and have side-effects.

Between her HIV and MDR-TB medication, Sandra takes twelve pills each day. The MDR drugs are difficult to take, she says, "you sometimes feel like you're losing your mind." She thinks people must have patience and courage to come through the treatment which can involve eight injections each day. She knows patients who passed away because they stopped their treatment due to the side-effects. Dr Master believes it is a systemic weakness in many areas of the country that patients have to self-treat. Places with treatment support programmes for TB patients show much better adherence and a higher cure-rate.

The length of time it takes to obtain results from a TB test also hampers efforts to combat the illness. The current testing method, which involves growing a culture from sputum taken from a patient, takes weeks to produce a result. Only then can the patient be diagnosed and start treatment. In the interim period that person and those around them are at great risk as the disease progresses and spreads. Efforts are underway to improve testing and in Khayelitsha in the Western Cape, Médecins Sans Frontières is currently trialling a new rapid diagnostic test called the GeneXpert.

The GeneXpert machine can test sputum samples and provide a result in less than two hours. It has the potential to rapidly improve testing and diagnosis efficacy which would reduce unnecessary deaths and halt the spread of the disease. Currently only "high risk" patients are screened, but the GeneXpert could screen everybody thanks to the rapid turnaround time. However the machine has several years of trials ahead before it could be rolled out for routine testing across South Africa.

In addition it is expected to be very expensive. The cost though will need to be weighed against the long term benefits to the health system of quicker and more accurate diagnoses of TB. Nathan Geffen is calling for activists to negotiate with government and engage with the manufacturer to bring prices down and expand access to testing and treatment. The GeneXpert and new drugs such as TMC207 (currently in advanced trial stages) are promising weapons in the battle against TB and MDR-TB. They will only be of use though if the people who need them most are able to access them.