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Six percent of new TB cases in Cape Town are drug-resistant

By Adriana Stuijt     Mar 23, 2009 in Health
At least 6% of people diagnosed with tuberculosis in Khayelitsha township near Cape Town, South Africa last year had a drug-resistant strain of the disease. This was reported by Medicines Sans Frontieres in a report on its pilot programme in the township.
Around 196 of the 6,000 people diagnosed with tuberculosis in Khayelitsha last year had the drug-resistant strain of the disease. Of those, three-quarters were also HIV-positive, said Goemaere. In an earlier report by the World Health Organisation, South Africa was identified as the 'epicentre of drug-resistant tuberculosis in the world.'
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If everybody was tested...
The international medical aid-agency said however that ' if all residents of the townshi, with its population of half a million people, were regularly tested, nearly 400 people a year would be diagnosed with drug-resistant TB,'.
MSF said this 'would give an incidence of DR-TB of around 60 per 100,000 people each year - one of the highest rates of DR-TB in the world," it said.
Treating TB without hospitalisation
MSF, the Cape Town city council and provincial authorities in 2007 launched a joint pilot project aimed at treating tuberculosis without hospitalising patients for long periods.
MSF said in eight of the country's nine provinces, patients had to contend with a waiting list at hospitals, and because of the difficulties of being isolated for treatment, up to a third never completed their treatment.
"Patients often spend at least six months in congregate wards. As these centres are often far from patients' homes, they are usually cut off from their families and livelihoods and feel abandoned."
High incidence of HIV in townships
MSF's medical co-ordinator for South Africa, Eric Goemare, said most treatment models for fighting drug-resistant tuberculosis were developed in eastern Europe and 'were not tailor-made for the townships, partly because of the high incidence of HIV there".
"The Khayelitsha project was therefore largely based on anti-retroviral programmes in community clinics, and aimed to make sure that people who had both HIV and TB got treatment for both.
It also sought to ensure that tuberculosis victims were diagnosed early, got the medication they needed, were monitored so that they could take it at home and felt motivated to take it for the required two years.
Urgently need better diagnostic tools
But Goemare said 'despite some success, it remained an uphill battle" to detect and treat cases as early as possible, and help patients cope with side-effects of TB treatment.
"In addition to new models of care... we urgently need better rapid diagnostic tools to detect DR-TB earlier, and less toxic, better tolerated, and more affordable drugs to treat patients."
The MSF's research in Khayelitsha had shown that most cases of DR-TB transmission occurred before the patient had been diagnosed or had begun treatment.
Goemare said his group was trying to inform the community on how to avoid infection in specific settings, including clinics, and at the same time 'debunk the myth that drug resistant Tuberculosis 'was a killer disease with no cure."
He said they were also 'teaching taxi owners to keep windows open and seats clean, and would soon start going to shebeens (township pubs) to tell clients how to reduce the risk of transmission.
He did not say how many of the 196 patients diagnosed with the drug-resistant strain had been cured.see
New TB-vaccine tested on South African babies
In a seperate development, a vaccine-test project has also been started in Worcester near Cape Town by drug companies testing out a promising new TB vaccine.
“This is an absolutely pivotal trial,” said Helen McShane, an HIV physician and researcher at Oxford, who created the most advanced experimental vaccine as a Ph.D. student in 1999. McShane incorporated a tuberculosis protein into a genetically manipulated smallpox vaccine to train the immune system to recognize and attack TB.
Finding Babies
Scientists will test McShane’s shot on infants at the Brewelskloof TB hospital in Worcester, South Africa, 120 kilometers (75 miles) north of Cape Town. The recruitment of babies will begin in early April, she said in an interview. All babies will be immunized with the BCG vaccine at birth. Half will receive the experimental vaccine at 18 weeks of age, while the rest will be given a dummy shot.
The study aims to show at least a 60 percent reduction in TB of the lungs among children given the experimental vaccine compared with those who got the placebo. Initial results may be available around 2011 or 2012, McShane said.
The BCG is given to about 100 million babies at birth each year, mostly in developing countries where there is high prevalence of the disease in the community. In infants, the shot helps prevent the most serious forms of tuberculosis, such as TB meningitis, which is often fatal.
McShane’s shot aims to stop tuberculosis developing in the respiratory system, where it enters the body in the form of microscopic bacteria carried in the air.
Worse in Africa
“This is the first of the new-generation TB vaccines to go into this kind of study looking at efficacy in infants,” she said. “It’s enormously exciting and I sincerely hope we will see some efficacy.”
The study, which will cost an estimated $14 million, is a collaborative effort with the South African Tuberculosis Vaccine Initiative and is funded by Aeras and the Wellcome Trust, the U.K.’s largest charity.
TB mortality rates are more than four times higher in Africa than elsewhere in the world, according to the WHO. More than 1.5 million new cases occur annually in Sub-Saharan Africa, the region accounting for a third of new cases of HIV, the AIDS -causing virus, worldwide each year. The human immunodeficiency virus attacks the body’s T-cells, the immune defenders that normally help keep pathogens such as tuberculosis at bay.
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