TB – Western Cape has supported decentralised treatment since 2010

Theuns Botha
Theuns Botha

At the SA National Tuberculosis (TB) conference in Durban last week, National Health Minister, Dr Aaron Motsoaledi, announced that government would increase the number of “decentralisation” sites providing drug resistant (DR) TB treatment from 100 to 2500.

The Western Cape Government welcomes this announcement. We have supported the decentralization of DR TB treatment since 2010 and this year we revised this treatment plan.

In fact, this month we launched a holistic communication strategy to address stigma around the disease and to encourage early detection and treatment for DR-TB. The focus of the strategy is to create awareness about the important role families and communities can play in the healing process of a family member suffering from TB.

Previously patients were hospitalized for a minimum of six months. The increased pressure on hospital beds led to a pilot study focusing on the  decentralized management of DR TB clients in the Khayelitsha sub-district in 2009. Lessons learned from  the pilot resulted in us changing our  provincial policy, leading to provincial wide decentralized management of DR TB in 2011.

This Policy Framework is based on sound evidence that decentralised DR-TB treatment provides more effective treatment for the patient, taking social and family pressures into consideration. In addition, decentralised care eases the burden placed on  hospitals.

This treatment approach created a number of other benefits including:

  • patients being able to receive treatment in the community they live in, thus maintaining their  family unit,
  • a decrease in the amount of days people are on  treatment, from an average of 72 days in the past, to an average of 11-23 days;
  • The roll out of GeneXpert, in the province which enables sputum lab results to be available within 12-48 hours ; and the
  • Establishment of the M (X) DR TB Review Committee, who is responsible for   reviewing chronic DR TB cases that are failing treatment and  advising  on appropriate management strategies.

The Western Cape has the third highest number of new TB infections in South Africa (909 cases per 100 000) after Kwa-Zulu Natal and the Eastern Cape. However, the Department is making significant progress in addressing the epidemic through the implementation of the Enhanced TB Response Strategy. The programme has improved the new smear positive TB cure rate from 79.4 per cent in 2009/10 to 81.7 per cent in 2012/13. Two districts (Overberg and Eden) achieved the World Health Organisation (WHO) target of 85 per cent. It must  also be noted that an increasing number of patients, especially within the context of the HIV epidemic, are sputum negative and not measured within the above mentioned cure rates.

The Western Cape has the highest  TB cure rate  in South Africa. The TB defaulter rate has also slowly decreased over the past few years with the implementation of various interventions and stands at 7.0 per cent in 2012/13 in comparison to the 9.4 per cent in 2008/09.

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