Health specialists and advocates say the tuberculosis epidemic, largely fuelled by HIV infection, requires massive social mobilisation and activism if the country’s TB Control Programme is to show better results.

“I think TB leadership has made a career out of poverty,” says Professor Francois Venter, head of the Southern African HIV Clinicians Society.

“They have done everything with the 10th rate drugs, fifth rate diagnostics for the longest time ever.

“You never see a TB person standing up and saying: ‘Why can’t I have better diagnostics? Why aren’t there better drugs?’.

“(With) HIV, we toyi-toyi until we get what we want. (With) TB, it’s like, ‘Oh, no, it’s too expensive’,” he says.

“(TB is) a disease that kills almost half of all South Africans and causes massive lung morbidity. You have a whole generation of people with destroyed lungs entering the medical system at the moment.

“But ‘TB is curable’ is the mantra that comes out. It’s a dreadful illness and yet, people still are trying to do it on the cheap.

“I think that we’ve saved money at the expense of the public good,” Prof. Venter says.

He furthermore states that what the fight on TB requires, is a civil society response that is equivalent to what characterised the fight on Aids in the 1990s.

“The HIV programme is not flawless. But HIV has drawn civil society together in this country in a way that nothing else has. And I think we need to acknowledge that.

“People who are standing up for TB now are not the TB people. It’s the people coming from the HIV world and the people with an understanding of systems,” adds  Prof. Venter.

Adila Hassim, head of litigation and legal services at Section 27, formerly the AIDS Law Project, agrees: “We haven’t seen the type of mobilisation that we saw in relation to HIV, and we need to be doing more in relation to TB.

“And I think it’s going to be inevitable that it’s the HIV community that picks it up. The reason for that is because that’s where the infection is felt the most.

“The other reason is that the HIV community, as a result of the years of activism, has become very well-versed in health, the right to health, health systems, how health is budgeted for, and treatment literacy. So I think it’s a good thing for the TB activism to reside there,” she says.

Health Minister Dr Aaron Motsoaledi, who is a member of the international Stop TB Partnership board – a grouping of 22 countries with the highest burden of TB – said in October last year, “We have been able to make public hysteria about HIV/Aids. (With) TB, we have not been able to.

“We have agreed that [this] year in April, we will meet in Washington for a special session where we will decide what public hysteria do we make about TB… the same hysteria as we made about HIV/Aids.

“And I’m accepting here… out of the Millennium Development Goals, we are not doing well on three Millennium Development Goals. And all three of them, by 2015, South Africa will never achieve if we don’t face HIV/Aids and TB head-on,” he added.

The emergence of drug-resistant TB makes it hard to control the epidemic. But pushing up the infection rates is the scale of HIV that we have in the country. This has resulted in what is now known as the twin epidemic of HIV and Aids.

“The co-infection rate is 73%. It’s the highest in the world, by the way. Our distant second is Zimbabwe. Countries which have (a) very big TB load, like China and India, only have a co-infection of 1.3% and 5%. But we have 73%, meaning that 73% of people who have TB are actually HIV-positive,” the Health minister said.

Prof. Venter says that the HIV/TB co-infection rate was “astonishing” and is “not understood”. He describes this as “a scientific failure”.

“The degree of vulnerability of people with HIV and the way it contributes to the spread within the communities is far greater than we’ve anticipated. And I think that the TB leadership, specifically, haven’t recognised their failure in this,” he adds.

“I like to tease the HIV-prevention people and say, ‘You know, if you were a company, they would just fire you all for results because even though you are very dedicated to your job, you’re not getting the results that you’re supposed to have.’

“Now, the same thing can be said for the TB programme. We’re getting absolutely astonishing bad results, despite pouring in more resources than any other African country into our TB programme,” says Prof. Venter.

For more than four decades, TB treatment has remained unchanged because scientists have not produced new treatment regimens.

A new strain of drug-resistant TB, which cannot be treated using the available drugs, has emerged.

Neither has there been improvement in the diagnostics for TB.

These are some of the challenges that fail TB control programmes around the world.

Khopotso Bodibe

Courtesy of Health-e News Service

Leading health professionals call to strengthen the fight against tuberculosis

TB is a bacterial infection that usually targets the lungs, but sometimes does spread to other parts of the body. Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks.

Approximately one-third of the world’s population is infected with the bacteria — Mycobacterium tuberculosis — that causes TB infection.

Although the bacteria is easily spread from person to person, by way of saliva spit into the air through coughing, only a small percentage of people (about eight million each year) will develop active TB.

Most people infected with the bacteria will never get sick and will remain unaware that they have latent (or inactive) TB throughout their lifetime.

People with HIV/Aids, with their weakened immune systems, are up to 800 times more likely to contract active TB.

In South Africa, a national survey estimated that 55% of TB patients were living with HIV in 2002.

Recorded TB deaths increased from 22 021 to 50 872 between 1997 and 2001, according to a Statistics South Africa study.

How do we treat TB and HIV?

Active TB is usually curable within six months, using a combination of antibiotics.

People with both HIV/Aids and TB require special treatment to combat both conditions, as some anti-HIV drugs and TB drugs interact poorly.

The South African National Antiretroviral Treatment (ART) Guidelines require a regimen change if the patient is already on ART, or a delay before the commencement of ART if the patient has not yet started treatment.

Thus, depending on the patient’s current health, the TB infection needs to be addressed first before an ART regimen can be started.