New ways of treating drug resistant TB
Floating above the top of the white mask stretching across her face,
Lydia Pinzie's dark brown eyes are spirited and alert, despite nearly
three years on toxic tuberculosis treatment.
Some white, some grubby, some askew, some comically large over the
faces of toddlers; the sea of masks in the waiting room at a South
African TB clinic harbour an often deadly drug resistant form of the
virus.
Every day Pinzie, 35, comes to this centre in Khayelitsha, some 40
kilometres (25 miles) outside Cape Town, to receive handfuls of
medication in the long and painful process to banish resistant
tuberculosis from her body, already battling AIDS.
"It is hard sometimes, you feel like vomiting and you feel dizzy, you
cannot do anything," she tells AFP at the clinic in the massive township
which is home to half a million people, over half of whom are jobless.
However, unlike patients in other parts of South Africa, after taking
her medicine Pinzie gets to go home again to her husband and child in a
pilot project which monitors treatment in the community.
Hospitalising patients suffering from Multiple Drug Resistant (MDR)
and Extremely Drug Resistant (XDR) TB in order to isolate them from
their crowded communities has often proved disastrous in South Africa.
Bored, depressed and ravaged by the treatment, which causes daily
nausea and leaves 20 percent deaf, patients escape from the hospitals
and abandon treatment, which encourages drug-resistance in the disease.
"I (would) run away. It is boring to stay at hospital without my
family. As a mother if you are not at home everything just falls apart,"
said Pinzie.
The clinic in Khayelitsha, where pioneering doctors first implemented
highly successful HIV treatment centres years before the government
agreed to roll out treatment, is trying to change the approach to
treating TB and remove the stigma around the disease. "It's a
revolution," says Doctors Without Borders medical coordinator Dr Eric
Goemaere.
It is hoped that shifting treatment away from specialised hospitals
to TB clinics where patients and their families are counselled and
taught infection control, will improve adherence to the medication
regimen.
With new drugs still far off "the only gain we can make is
adherence", says Goemaere.
Determining that a patient has a drug-resistant TB strain can be
arduous. Pinzie took normal TB medication for six months, fell sick
again, was on medication for another eight months and only then was
diagnosed with the resistant form.
Now she has six months left of the two year treatment for MDR-TB,
which costs almost 250,000 rand (26,000 dollars,19,000 euros).
With nearly three-quarters of TB sufferers also HIV positive,
providing a one-stop service has had a high level of success.
The World Health Organisation estimated that there are around 14,000
cases of MDR-TB in South Africa, around ten percent of which are XDR-TB,
but these figures are believed to be a drop in the ocean.
Fear of XDR-TB has exacerbated the stigma of TB since it was first
discovered in Kwazulu-Natal in 2006. In one case, all but one of a group
of 53 people with the strain died within 25 days of diagnosis.
"We don't know the size of the problem. We have no clue how many
people are dying of drug resistance.
"They are dying before diagnosis is made," said Dr Virginia Azevedo,
district manager for the city's health department. The clinic in
Khayelitsha has cured 77 percent of its infectious cases.
Khayelitsha has a TB incidence rate of at least 1,500 per 100,000
people, of which 60 are drug resistant, one of the highest rates in the
world.
AFP
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