Eastern Cape Tuberculosis levels slowly rising as burden shifts to clinics

Eastern Cape Tuberculosis levels slowly rising as burden shifts to clinics

The number of cases of Tuberculosis (TB) in the Eastern Cape is on the increase, while treatment success is declining following the closure of specialised TB hospitals, which has shifted the treatment burden of this disease to local clinics.

Today is World TB Day, which focuses on awareness around TB, which is an infectious airborne disease caused by mycobacterium tuberculosis and is a serious public health threat. The emergence of Multidrug-resistant TB (MDR-TB) and Extensively drug-resistant TB (XDR-TB) strains, which are resistant to the standard first-line anti-TB drugs, has further complicated matters.

By shifting the treatment to clinics, not only has the Health Department increased the risk of others being exposed to these drug-resistant strains of TB, but it also becomes harder to ensure that treatment protocols are adhered to.

In the Eastern Cape, like in many other regions with high TB burden, MDR-TB and XDR-TB have been significant challenges. Factors such as poverty, overcrowding, HIV/AIDS prevalence, and inadequate healthcare infrastructure contribute to the spread and difficulty in managing these drug-resistant forms of TB.

Years ago, the Department introduced the 90-90-90 campaign, which seeks a 90% screening of patients, with 90% of screened patients placed on medication and a 90% treatment success rate. However, following the establishment of the TB Caucus in the Provincial Legislature last year October, it has become apparent that while the first two objectives appear to have been achieved, the treatment success rate is dismal, currently at only 74.2%.

Patients who receive treatment often tend to stop taking TB medication when they feel better and are described as Lost To Follow Up (LTFU). This is a very dangerous practice as the TB bacteria can become resistant to that medication. This drug-resistant TB can be spread to others, compounding the problem.

It is, therefore, vital that Health MEC, Nomakosazana Meth, reconsider closing these specialist TB hospitals and at least keep some sections of these hospitals open to comply with one crucial aspect of the TB Caucus’s recovery plan, namely the retention of patients in care.

This would serve to dramatically reduce patients who are LTFU, as well as reduce the exposure of non-TB patients to TB patients with MDR or XDR TB at clinics.

To improve the health outcomes for TB patients across the province, the political will to improve governance and accountability is critical. Sadly, according to the Auditor General’s report from last year, governance and accountability are LTFU in the Health Department.