WORLD TB DAY: TB will not end unless these barriers are tackled

Thursday, March 22, 2018 — Tuberculosis (TB) remains the leading cause of death in South Africa, and yet it is curable. Why have we not overcome this fatal disease?

Numerous challenges exist at every level of TB diagnosis and care—not only in South Africa, but around the world, where one person dies every 18 seconds from TB. 

On this year's World Tuberculosis Day, Doctors Without Borders (MSF) profiles five key strategies on which government and donors should focus their finances and efforts in order to #StepUpForTB and end the deadly TB epidemic.

Five key strategies

  1. Toxic Treatment
  2. Unidentified TB cases
  3. Lack of social support
  4. Centralized drug-resistant TB (DR-TB) care
  5. Stigma
Close up of sachets of the drug Delamanid in the Town 2 Clinic, Kuyasa, Khayelitsha, Western Cape in South Africa. Photographer: Sydelle WIllow Smith
MSF MDR and XDR-TB patients meet weekly at the community-based DR-TB care facility Lizo Nobanda, located in Khayelitsha, a township outside Cape Town.<br/><br/>In 2013, support group members joined MSF TB blogger Phumeza Tisile and Dr Jennifer Hughes is helping draft MSF's DR-TB manifesto, "Test Me, Treat Me." Their support group counsellor, Busisiwe Beko, joined the group in helping draft the manifesto. Here, a support group members holds a placard stating their demands. Photographer: Samantha Reinders
Nanyanyiso Baloi takes her treatment regimen for pre-XDR-TB, which includes Delamanid and Bedaquiline, Western Cape. Photographer: Sydelle WIllow Smith
Simphiwe holds his medication, he takes up to 26 pills a day to treat XDR-TB. Here he holds his morning selection, which includes delamanid, one of the newest DR-TB drugs, which Simphiwe is taking for the first time today. Photographer: Sydelle WIllow Smith
South Africa has one of the highest burdens of TB and (Drug Resistant) DR-TB in the world, with around 20,000 people diagnosed with DR-TB in 2015. In Khayelitsha, Western Cape, which has some of the country’s highest rates of DR-TB, MSF runs a strengthened regimen programme that incorporates new drugs into treatment regimens for DR-TB patients including Delamanid and Bedaquiline.<br/><br/>Dr Jennifer Hughes, MSF TB doctor (MSF178122) said of Sinethemba:<br/><br/>“Sinethemba was one of the first patients that we put on delamanid. I’ve seen a huge improvement. We pay particular attention to young patients so that we can share our experience and add to the limited information available on use of delamanid in people under 18 years. <br/>We have a lot of contact with Sinethemba and her grandmother; they’re always calling us, sending us SMSes.<br/>Early on, she was able to stop the painful kanamycin injections-- which are a particular concern in children due to the notable risk of permanent hearing loss--because it was discovered that her TB was resistant to the injectable anyway.<br/><br/>You can’t underestimate the tremendous psychological boost that a patient and the family gets when they realise there is a drug that has promise. This may also have an impact on recovery. <br/>But so far, our patients report fewer side effects related to delamanid compared to other DR-TB medications and anecdotally it seems to be very well tolerated. <br/>Sinethemba’s sputum cultures have remained negative (i.e. no active TB detected) since March 2016. This means that the disease is under control and she is highly unlikely to pass on the resistant bacteria to anyone else. <br/>If she sticks to her treatment well and her sputum cultures remain negative by September 2017, she’ll be discharged as cured of DR-TB (WHO recommended guidelines for 18 month confirmation time). As she is responding so well to the treatment so far, we have received approval for her to receive an additional six months of delamanid along with her other medications.”<br/>Overall, six patients in Khayelitsha have now completed the first six month period of delamanid and all six have been approved for extension of taking delamanid beyond eight months. Clinicians can apply for extensions for patients if they feel that the remaining drug regimen would be inadequate without it, or if the patient is responding positively but slowly to treatment and needs more time. Photographer: Sydelle WIllow Smith
Tuberculosis is the biggest killer of people living with advanced HIV, with over 400,000 patients dying each year from the disease. People with advanced HIV, also known as Acquired Immune Deficiency Syndrome (AIDS) have very weakened immune systems, leaving them susceptible to common infections like TB, which can quickly become deadly.<br/><br/>Yet TB can be difficult to diagnose in people living with HIV. More than 50% of people with TB/HIV co-infection are unable to produce enough sputum, have low sputum bacillary loads or have extrapulmonary TB which is not diagnosed through sputum.<br/><br/>Simple, more accurate tests are needed. TB-LAM, a rapid, point-of-care urine test, detects lipoarabinomannan (LAM), which is a marker of active TB disease. The WHO recommends TB-LAM specifically for helping to diagnose TB in HIV-positive adults with TB signs and symptoms and a CD4 cell count of ≤100 cells/μL, or those who are very sick, at any CD4 cell count. Since it delivers results in less than 30 minutes and is priced between US$ 2.6643 and US$ 3.50 per test, TB-LAM can be a valuable tool for identifying people with the most urgent need for TB treatment. Photographer: Sean Cleere
Tuberculosis is the biggest killer of people living with advanced HIV, with over 400,000 patients dying each year from the disease. People with advanced HIV, also known as Acquired Immune Deficiency Syndrome (AIDS) have very weakened immune systems, leaving them susceptible to common infections like TB, which can quickly become deadly.<br/><br/>Yet TB can be difficult to diagnose in people living with HIV. More than 50% of people with TB/HIV co-infection are unable to produce enough sputum, have low sputum bacillary loads or have extrapulmonary TB which is not diagnosed through sputum.<br/><br/>Simple, more accurate tests are needed. TB-LAM, a rapid, point-of-care urine test, detects lipoarabinomannan (LAM), which is a marker of active TB disease. The WHO recommends TB-LAM specifically for helping to diagnose TB in HIV-positive adults with TB signs and symptoms and a CD4 cell count of ≤100 cells/μL, or those who are very sick, at any CD4 cell count. Since it delivers results in less than 30 minutes and is priced between US$ 2.6643 and US$ 3.50 per test, TB-LAM can be a valuable tool for identifying people with the most urgent need for TB treatment. Photographer: Sean Cleere
Ubuntu clinic (integrated TB/HIV) in Khayelitsha. Photographer: Henrik Glette
Angela Makamure Press Officer at Doctors Without Borders (MSF) Southern Africa