Despite a multipronged approach to tackling tuberculosis (TB), the epidemic has not slowed down in South Africa.
Over the past few years, the health department has strengthened its work in supporting patients and encouraging people to get tested for TB. It has worked with a range of nongovernmental organisations (NGOs) to boost awareness of the disease. Volunteers have been trained to support TB patients, while nurses from the local clinics regularly make “contact” visits to patients and their families.
Yet over 400Â 000 new infectious TB cases are still reported every year and South Africa holds the dubious record of having one of the highest TB burdens in the world.
An extensive study into TB and HIV in the Western Cape and Zambia provides some hope that this could change if more intensive work is done in encouraging people to get screened for TB.
A seven-year-long research project of the Desmond Tutu TB Centre at Stellenbosch University, the Zambia Aids Related TB (Zambart) Project and the London School of Hygiene and Tropical Medicine have found that “household counselling” dramatically reduced the prevalence of TB.
The study, known as Zambia-South Africa TB and Aids Reduction (Zamstar), was carried out in 24 communities across Zambia and the Western Cape. The results were released at the 42nd World Conference on Lung Health in Lille, France, recently.
It showed that “household intervention” reduced the prevalence of infectious tuberculosis in these communities by 22% compared to the communities that weren’t visited. It also halved the risk of children being infected by TB.
Offering hope
Teams, which included trained counsellors, visited the homes of TB patients in 9Â 000 households in the Western Cape and Zambia. Each household was visited at least three times. Family members were screened for TB and encouraged to talk about their concerns about HIV and TB.
The director of the Desmond Tutu TB Centre, Nulda Beyers, said the caring attitude shown by Zamstar teams when visiting people went a long way in prompting them to get diagnosed and treated for TB. This likely affected the drop in the prevalence rate.
“Instead of simply instructing people to go to the clinic, our Zamstar teams spent time with people in a supportive and caring way.”
Many of the participants in the study in both Zambia and South Africa said they’d been treated with dignity and respect during the home visits.
“I have seven children who were counselled and screened for TB. They were all diagnosed with TB, but through medication, they are all well now,” said one of the participants in the study.
“The greatest thing that enables us to survive is to offer hope,” said another of the community members.
What works
Clinics fast-tracked TB screening and sputum collection and Zamstar attempted to diagnose patients within 48 hours.
“The good news is that we’ve now got evidence of what works for TB control,” said Yogan Pillay, the head of TB and HIV programmes at the health department.
“Do we need to go beyond the clinic and into the community to control TB? It’s an unequivocal yes. TB lives in communities and households. We need to find people and diagnose and treat them,” said Pillay.
The research dovetails with the department’s plan to train thousands of healthcare workers and “health promoters” in the community.
The Zamstar project was the biggest study ever undertaken that attempted to better understand what works best in controlling TB and HIV beyond the confines of clinics and hospitals.
The research found that many people with TB do not go to clinics to get screened. When they do go, clinic staff members often don’t suspect TB readily enough.
“If adults with TB are not diagnosed and treated, they can infect children. Zamstar found that the transmission rates are still higher than all the previous community-based surveys in Africa, with up to a third of our grade one to three schoolchildren already infected with TB. This cannot be allowed to continue,” the researchers said.
“Up to 20% of infectious TB is found in children — and it’s far more difficult to diagnose and treat,” said researcher at the Desmond Tutu TB Centre, James Seddon.
He said it’s vital to raise awareness about the importance of prevention and treatment for children.
‘Shocking’ statistics
Zamstar’s principal investigator, Helen Ayles,agreed with these sentiments.
“In many communities TB and HIV affect the whole household, so you need to involve not only the TB patient, but his or her entire family.”
The study also revealed a dangerously high TB infection rate in the Western Cape.
The prevalence of TB in the eight communities in and around Cape Town in which the study was conducted was four times as high as in the Zambian communities.
“These statistics are shocking. It means that one in 50 people in the communities we covered has infectious TB. As researchers we have a moral obligation to ensure that our findings lead to better health care for vulnerable people,” said Beyers.
She said it was vital for academics to work in partnership with the health department and NGOs to jointly tackle the TB epidemic in the country.