South Africa has the sixth highest burden of TB in the world after China and India – almost 1% of the South African population are diagnosed with active TB every year. While the number of TB patients initiated on treatment under the National TB Programme appears to be decreasing over the last four years, the number of multidrug-resistant TB (MDR-TB) cases is escalating. Director of Corporate Affairs and Market Access at Lilly South Africa, Belinda Bhoodoo, explains how the Lilly MDR-TB partnership is supporting government’s drive towards the decentralisation of MDR-TB treatment as well as maximising reporting and advocating efforts to scale up models of care.
The Lilly MDR-TB partnership is focused on meeting the challenges of treating MDR-TB and extensively drug resistant TB (XDR-TB) and focuses its activities on KwaZulu-Natal and the Eastern Cape, the provinces with the highest burden of MDR-TB in South Africa.
Treating and curing MDR-TB demands an intensive treatment regimen and an immense amount of personal commitment, sacrifice and discipline on the part of the patient. Prior to any decentralisation efforts, people seeking treatment for TB often faced delays in hospital admissions, long and costly travel, extensive time away from families and work, and other barriers. While infectious, patients must remain hospitalised, isolated from their families and communities and unable to work and earn an income – this can be for months on end. Treating MDR-TB has a significant negative impact on the social and economic status of the individual and family due to the long hospital stay.
Decentralisation of TB treatment
The aforementioned factors led to the National Department of Health (NDoH) launching a plan in 2011 calling for decentralisation of TB care. Up until this time, although TB detection was decentralised – in other words could be detected in outlying clinics and hospitals, its treatment remained centralised in large hospitals in urban areas. Through decentralisation, the NDoH aims to reduce the transmission rates of MDR-TB by initiating treatment sooner, improving adherence to treatment regimens and supporting patients closer to their homes.
MDR-TB is much harder to treat and has a significantly poorer cure rate. Drug-resistant strains often require more medicines and can take up to two years to treat successfully. Patients with MDR-TB can spend months in hospital as they need to receive daily injections until they have two negative TB culture tests for two consecutive months. After this, they are no longer infectious.
Although patients are required to stay in hospital until they have two negative TB cultures, some are now discharged before that to get the remainder of their treatment at local clinics, but only if they have negative smear microscopy results. Once MDR-TB patients have converted from positive to negative TB cultures they have to continue taking drugs for about 18 months, and this requires regular trips back to the hospital or local clinic for treatment drugs and check-ups which must happen without fail. There is also the very real challenge of taking care of families and children during the time that a parent or breadwinner may be unable to do so.
Lilly MDR-TB partnership
Given these challenges for the patient, it’s easy to see why so many fail to complete the required treatment regimen and fall by the wayside. A key focus of the Lilly MDR-TB partnership is providing research support to find better models of treating TB so as to improve treatment outcomes for people living with MDR-TB. In order to support and advance the decentralisation process, the Lilly MDR-TB partnership is further investing heavily in the training and capacity building of healthcare providers in comprehensive patient care, as well as the supply and access to second-line medicines. It also supports thousands of families in at-risk communities through community-based education and psychosocial services.
We need patient-centred services where individuals can access treatment closer to their homes, and much faster. In addition to this, the Lilly MDR-TB partnership is committed to supporting research for greatly needed new TB medicines since most current medicines used to treat TB are at least 50 years old. The partnership continues to support the NDoH’s strategic plan by collecting evidence-based data that will be used to inform national and provincial decentralisation efforts.
TB has been labelled as a disease of poverty, but the reality is that as an airborne disease anyone can contract it. This makes TB everybody’s business. We’re proud to play a role in an exceptional public private partnership, working together with the NDoH to drive improvements in outcomes for the victims of this debilitating disease.