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New approach urged in drug-resistant TB

15th September 2008

South Africa is experiencing more riots by patients infected with multidrug-resistant tuberculosis and locked up to prevent the disease from spreading - but some say a new treatment model involving home-based care might help curb transmission.

In July a provincial High Court ruled that forcibly isolating patients with drug-resistant tuberculosis is legal, and two South African provinces have implemented strict programmes to do exactly this.  But infections rates haven’t slowed. And how South Africa copes with this challenge, made worse by poverty and HIV/AIDS, raises questions about how the continent - plagued by war and poverty - should address it.

South Africa will invest an additional US$50 million on isolation beds for people with drug-resistant TB. Some 7,000 cases of multidrug-resistant and extensively drug-resistant TB were logged in 2007, up from less than one-third that number in 2001.

Very few South Africans with contagious TB are in fact hospitalised at all. Diagnosis of drug-resistant TB can take two months in South Africa, and waiting lists for treatment in provinces where admission to hospital isn’t required often exceed the number of patients in lock-down facilities.

Francois Venter, who heads the HIV Management Cluster at the University of Witwatersrand's Reproductive Health and HIV Research Unit in Johannesburg, said this doesn’t make sense. He cites community-based models of multidrug-resistant TB treatment used elsewhere as more effective models - in which local health workers are trained to treat patients who have TB and multidrug-resistant TB at home.

That means keeping contagious patients away from the most vulnerable hospital populations, while lowering the odds that patients will drop out because they can’t afford to travel to treatment centres.

The Stop Tuberculosis Partnership estimates that Africa will need an additional US$10.7 billion to fight TB effectively over the next decade.

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