#WorldTBDay: increase in drug-resistant tuberculosis

While the incidence of drug-susceptible tuberculosis (DS-TB), which is treated with the antibiotics rifampicin and isoniazid, has declined slightly over the past decade, there has been a marked increase in drug-resistant tuberculosis (DR-TB).

“We are seeing an increasing number of patients who have never been treated for drug-susceptible TB are developing drug-resistant TB. That means they are infected with drug-resistant TB,” says Dr. JN Thandi Dlamini-Miti, Technical Advisor for Drug-resistant TB at Right to Care.

“Drug-resistant TB requires a patient to take more drugs and for longer periods of time, from nine to 24 months, placing a heavy burden on patients, families and the state. Side effects are more common and more serious.

Right to Care works with the Ministry of Health to increase early diagnosis of TB, detect resistance, remove barriers to treatment, improve patient adherence and strengthen infection control. “It involves simple actions like sneezing or coughing into your elbow or a tissue and making sure windows are open – at home, on public transport and in healthcare settings,” she says.

Early diagnosis and treatment of drug-resistant TB is essential to prevent its spread.

Expand the program

“The National Department of Health’s decentralization policy to expand MDR-TB treatment from specialist drug-resistant TB hospitals to regional and district hospitals and primary health care facilities has been an important intervention. It enables treatment to be started earlier, improves compliance and supports patients closer to home. USAID funds our activities in some districts where we support the decentralization program,” says Dlamini-Miti.

Progress is being made in the treatment of tuberculosis. “The South African rollout of drug-resistant TB drug bedaquiline, which was the first new TB drug in almost 50 years, is being followed by a new drug, delamanid. We support the national TB program with MCC registration of sites and clinicians, training, data management, drug distribution and tracking. “Delamanid was donated to SA by Japanese drugmaker Otsuka Pharmaceuticals,” she says.

Adhesion

Adherence is a critical factor because poor adherence can lead to increased drug resistance and even death. Some MDR-TB regimens require the patient to take 17 pills a day, and patients may experience side effects, including hearing problems. “Monitoring by a multidisciplinary team is therefore essential. Social workers, dietitians, audiologists, counselors, pharmacists, nurses, and physicians should all be involved in a patient’s progress,” says Dlamini-Miti.

“In South Africa, TB also contributes to around 25% of HIV-related deaths. It is estimated that approximately 70% of new cases of tuberculosis in adults are co-infected with HIV. The risk of tuberculosis in people living with HIV can be significantly reduced by antiretroviral therapy and isoniazid preventive therapy, but adherence remains the main challenge,” she says.

World Tuberculosis Day is March 24, 2018.

Sherry J. Basler