Tuesday, December 7

South Africa sets another example of success in beating tuberculosis | On the front line | Future Planet


During the Union’s 52nd World Conference on Lung Health in late October, Doctors Without Borders (MSF) announced the results of TB-PRACTEAL, the first multi-country randomized controlled clinical trial to report on the efficacy and safety of a multidrug-resistant tuberculosis (MDR-TB) treatment. Time has shown that MDR-TB is a very difficult form of tuberculosis to treat, requiring multidrug therapies to be administered over a period of nine to 24 months.

MSF and its partners tested a four-drug treatment (known as BPaLM), which contains two or three new substances developed in recent years. The study compares the results of this biannual four-element therapy with those obtained in a group that received the usual treatment for MDR-TB accepted in the area and offered by the public health system. An overwhelming 89% of the patients who followed the new therapy were cured, compared to 52% of the group who received the conventional care.

The news is excellent, and we hope that the results of the trial will add to the growing evidence from other sources, and that treatment recommendations will be updated globally. In many countries around the world, people with drug-resistant TB continue to endure long and toxic treatments of up to 20 months that can include painful injections and up to 20 pills a day.

People with resistant TB endure long and toxic treatments of up to 20 months that can include painful injections and up to 20 pills a day

However, the fact is that with a shorter and more effective treatment, the number of pills to be taken remains high, the side effects are also many and the duration of therapy is just as tiring.

It is imperative that, in addition to these advances in treatment, we invest in early case detection and disease prevention wherever we can. Collectively, we are failing people in those areas miserably, and COVID-19 has made the situation worse.

This fact was in scandalous evidence last month, when the World Health Organization (WHO) published the World Tuberculosis Report 2021, which shows that mortality related to this disease has increased for the first time since 2012, with 1.5 million deaths in 2020.

At a high-level United Nations meeting in 2018, the TB community pledged to initiate TB treatment in 40 million people, and to treat another 30 million with preventive treatments from then until 2022. However, we know that Instead of advancing, in 2020 the diagnosis was reduced by 18%. This means that almost half of the 10 million people estimated to be infected in 2020 were not diagnosed or started treatment. Even before COVID-19, the global TB community had lamentably fallen short of the 2020 target, having eliminated the catastrophic costs for the sick, with an estimated 50% of people suffering from the disease. disease and face their terrible reality for life and well-being, they become impoverished and limited by it.

But it is the daily reality that makes us realize what this calamity means. In Khayelitsha, near Cape Town, the Kuyasa family lives in a 30 square meter house (smaller than a garage) on a busy street. In 2019, a family member fell ill in the neighboring Eastern Cape province. She was diagnosed with drug-resistant tuberculosis and began treatment. The young man lived far from any source of water, and since he was ill, in 2020 he decided that it would be better to go with his family to the Khayelitsha neighborhood, in the Western Cape province. It was the time when people were confined at home complying with the rules of closure due to covid-19, and when the young man felt ill again, the other adults in the family unit worried about his well-being, for his own health and for the health of your children.

Could it be covid-19? The patient was tested, and the result came back negative. No, it was tuberculosis, and it was active, because in June 2020 her sister Sinidiswa was diagnosed with the multi-resistant strain of this infection, and the same thing happened shortly after with three of the six children in the house, while a fourth was diagnosed drug-resistant tuberculosis. The young man died as a result of the disease. Imagine the situation at that moment: five infected people in a desolate home with no financial support, living all day under the same roof, including the four members who still showed no symptoms.

A devastating image. However, this story instills some hope.

When Sindiswa went to the nearest clinic and was diagnosed, the young woman made the brave decision (because the disease continues to carry a great stigma in the community) to make the family situation known to the doctor, nurses and counselors who treated her: his sick brother and many family members under one roof, including several children. Part of his medical team works for MSF, an organization with a long history of collaborating with the communities of Khayelitsha and the Department of Health to fight MDR-TB. When Sindiswa was diagnosed, one of the organization’s main areas of interest was identifying and screening all contacts of MDR-TB patients within the family unit, especially children.

An important aspect of this work was the administration of preventive treatment to those who had been exposed to the infection to prevent them from developing the disease. Thanks to this program and the willingness of the Kuyasa family to participate, four children were diagnosed who otherwise would not have received an opinion until later, and were identified as having the bacillus at an early stage, when the disease was still it was mild. The little ones were put into treatment and were able to go back to school. The three members of the family who were not infected began preventive therapy so that they would not develop it.

Thanks to home care for patients with covid-19, the diagnosis and treatment of multidrug-resistant pediatric tuberculosis increased six-fold

The results and experience of this program were also presented at this year’s Union conference, within a multidisciplinary session chaired by Norbert Ndjeka, the South African Government’s benchmark for multidisciplinary tuberculosis. The MSF team explained that it had started by caring for the homes of the sick in response to COVID-19, and that in the process they realized that the strategy significantly improved the services they provided. These services included compassionate counseling for the entire family unit, the identification of people with MDR-TB – especially children – in the initial phase of the disease, and the provision of preventive anti-tuberculosis treatment to members of the family. family who breathed the same air.

Thanks to this work, the diagnosis and treatment of pediatric multidrug-resistant tuberculosis multiplied by six, 150 child and adolescent contacts were identified, and 119 began preventive treatment of the disease.

The goals of this year’s UN high-level meeting, focused on the initiation of treatment and prevention of tuberculosis, were not mere paper. They represent the work that must be carried out if we really want to end this disease. The fact that we are so far from reaching them shows that we are failing on a fundamental level, and that we have an obligation to sound the alarm, but also to show the way forward. The Khayelitsha model developed during COVID-19, and from which the Kuyasas benefited, shows exactly how to do it.

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