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TB overshadowed by HIV/Aids

”HIV/Aids is about sex; TB is about sputum,” said Dr Francois Venter, the head of the HIV Clinicians’ Society, at a debate held in Johannesburg this week on the challenges of fighting tuberculosis (TB) in South Africa.

Venter, who is also the head of HIV management at the University of the Witwatersrand’s reproductive health and HIV research unit, said TB research is at least a decade behind HIV/Aids research.

It is also easier to attract funding for HIV/Aids programmes than for TB.

Rural doctor Hugo Templeman, the founder of the Ndlovu Medical Centre in Elandsdoorn, Mpumalanga, said he has never found it difficult to secure funding for HIV/Aids programmes.

”We are a middle-income country, but we spend little money on health and little money on TB”, he said.

The budget for HIV/Aids programmes in South Africa for 2007/08 is R3,078-billion. Of this amount, R2 585 423 000 goes to provinces as a conditional grant. The remainder — R492 615 000 — is used nationally for coordination and administration, says Health Department spokesperson Fidel Hadebe.

According to the 2008 Global Tuberculosis Control Report of the World Health Organisation (WHO), the national South African TB budget for 2007 was $378-million (about R2,9-billion) — a much higher budget than those of previous years because of the implementation of the government’s five-year strategic plan to battle TB.

TB is the leading cause of death among people living with HIV/Aids. It has been estimated by the WHO that worldwide, someone is infected by the tuberculosis bacilli every second.

In 2006 in South Africa, there were an estimated 341 165 TB carriers, up from 109 000 in 1996. The Health Department said this week, however, that multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are showing signs of decreasing. The department said it will release the figures showing the decrease in due course.

In 2005, 675 per 100 000 people died from HIV/Aids in South Africa. In 2006, 218 per 100 000 succumbed to TB.

According to the Health Department, the cure rate of TB has gradually increased over the past five years from 50% in 2001 to 58% in 2005. The rate of treatment has also climbed from 60% in 2001 to 71% in 2005.

However, the success rate in South Africa remains low, with death and defaults (TB patients who do not complete their course of medication) the most frequent negative outcomes, said the WHO in its 2008 TB report. According to the Department of Health, the TB defaulter rate is currently 9%. High numbers of defaulters create a barrier to achieving the targets for successful treatment.

Mark Heywood from the South African National Aids Council (Sanac) said it is time to rethink the current TB policy. ”It’s insufficient to just run adverts that TB can be cured. That doesn’t motivate people to continue taking their medicines when they start to feel better.”

A special difficulty in treating TB is the long diagnosis time. However, on July 1 this year the Health Department launched a new diagnostic method to detect MDR-TB. This method, in which DNA is collected from a swab of a patient’s saliva, will cut the diagnosis time from two to three months to just a day or two.

With the new method patients no longer have to wait for extended periods for test results — a time during which they could spread the disease to others. Some patients even died before their test results were determined. The improved diagnostic method will be made available to 16 nations in Africa.

In 2007 the government introduced a five-year strategic plan to fight TB. As part of this programme the government has so far trained 128 healthcare workers on infection control, 604 on the use of the electronic TB register, 177 on data management and 2 211 on clinical management.

Heywood said at this week’s debate that HIV/Aids has come to be thought of as a human rights syndrome. But, ”health is a human right and it’s the obligation of the state to guarantee this right”, he added.

Venter said that TB, more than HIV/Aids, is a disease of poverty, and ”we cannot fight it on a shoestring budget”.

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Imke Van Hoorn
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