Covid-19 a ‘hammer blow’ for TB

Deputy President David Mabuza, in his capacity as Chairperson of the South African National AIDS Council, receiving a Memorandum of Demands from the Treatment Action Campaign (TAC) on the sighlines of the World TB Day commemoration, at Ehlanzeni District Municipality in Mbombela, Mpumalanga province. Photo GCIS

Deputy President David Mabuza, in his capacity as Chairperson of the South African National AIDS Council, receiving a Memorandum of Demands from the Treatment Action Campaign (TAC) on the sighlines of the World TB Day commemoration, at Ehlanzeni District Municipality in Mbombela, Mpumalanga province. Photo GCIS

Published Mar 25, 2021

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Cape Town- The Covid-19 pandemic has interrupted the global fight against tuberculosis with an estimated 1.4 million fewer people from 80 countries receiving care in 2020 than in 2019.

The World Health Organisation (WHO), in marking World TB Day, ranked South Africa among the countries with the biggest relative gap in care-receiving, at 41%. Indonesia, the WHO announced from preliminary data, showed a gap of 42%, the Philippines at 37%, and India 25%.

Deputy President David Mabuza, in his capacity as chairperson of the South African National Aids Council received a Memorandum of Demands from the Treatment Action Campaign (TAC) noting that the WHO further ranked South Africa as one of the top 20 countries in terms of TB burden over the past two decades.

“In accepting the memorandum from the TAC, Deputy President Mabuza has emphasised the government's commitment to work together with all civil society organisations in finding the missing TB patients and ensuring adequate treatment for those affected,” the government said.

In the Western Cape, Premier Alan Winde announced that not enough people were being tested to pick up new

TB cases. Winde said that the Covid-19 pandemic was a “hammer blow” to efforts to respond to TB.

“Globally, it is estimated that the Covid-19 pandemic has set back the fight against TB by between five and eight years and could result in an additional 6.3 million cases of TB between 2020 and 2025.

“In the Western Cape, TB test positivity rates increased over the last year, hitting a high of 21% in September 2020. This indicates that we were not testing enough people to pick up new TB cases,” Winde said.

TB remains one of the world's deadliest infectious killers, with nearly 4 000 people losing their lives each day and close to 28 000 people falling ill with the preventable and curable disease.

The WHO said the preliminary data showed a 21% global drop in care for TB patients.

“The effects of Covid-19 go far beyond the death and disease caused by the virus itself. The disruption to essential services for people with TB is just one tragic example of the ways the pandemic is disproportionately affecting some of the world's poorest people, who were already at higher risk for TB,” said Dr Tedros Adhanom Ghebreyesus, WHO director-general.

“These sobering data point to the need for countries to make universal health coverage a key priority as they respond to and recover from the pandemic, to ensure access to essential services for TB and all diseases.”

The WHO said before Covid-19 struck, the gap between the estimated number of people developing TB each year and the annual number of people officially reported as diagnosed with TB was about 3 million.

The pandemic has exacerbated the situation, they said.

A mobile X-ray clinic was yesterday unveiled by the provincial Department of Health and the City at Brooklyn Chest Hospital, Ysterplaat, which has been screening people since March 1.

Winde said the unit will further aid in treating TB in communities and was made possible through a partnership with TBHIV Care and the Global Fund.

THEY walked in single file through the narrow alleyways winding away from their tin shack in Cape Town towards the health centre. Keitu – just 11 years old – carried her baby brother on her back since their mother was too frail and could barely manage on her own. Keitu kept a close eye on her young brothers as well. They had been acting out since their father died of drug resistant tuberculosis (DR-TB) several months earlier, and they were grumpy after not having eaten anything but porridge in the last three days.

The nurse working in the health centre had begged them to come in. Keitu’s mother had been diagnosed with DR-TB as well and, since the family all breathed the same air within their one-room dwelling, there was a chance the children might have it too.

The boys – aged four and six – and the baby were too young to understand, but Keitu knew enough to be afraid. She had watched her father waste away for seven months, even though he took all his medicine before he died.

His skin had turned orange; at the end he was too weak to respond to her as he gasped for breath on his thin mat. Keitu chanted quietly to the children during their difficult walk: “Be brave, be brave, be brave.”

Although the World Health Organization (WHO) recommends that all household contacts of people living with DR-TB be assessed as quickly as possible after someone in the family is diagnosed with the disease, poorly resourced programmes can do little more than make lists of the contacts who might have been exposed.

Out-dated and ineffective methods of screening for DR-TB mean that many people who are sick are simply missed. This problem is especially significant among children, since many cannot produce the sputum needed to diagnose DR-TB.

Instead, children have to undergo gastric washing – an intrusive and painful procedure, where a long tube is placed down a child’s nose into their stomach to try to suck out any sputum they may have swallowed.

In many places, children are not able to access the most effective medications, including newer drugs like bedaquiline and delamanid, because they were not included in studies of these lifesaving treatments. Instead, they are given old medications, which come as adult-sized tablets that have to be cut, crushed and mixed before they can be given to children. In the worst instances, children are still treated with a daily injection.

Doctors without Borders (MSF) is addressing these issues in projects in South Africa and India. Through its post-exposure protocols, MSF is actively seeking out people who may have contracted DR-TB, and screening all children and adolescents in a household where someone has been newly diagnosed.

The organisation is piloting the use of stool samples, rather than gastric washing.

In one project in South Africa, MSF is giving children and adolescents who have been exposed to DR-TB, but are not yet sick, preventive treatments to dramatically decrease their chances of developing DR-TB.

By actively looking for the disease in exposed children, MSF is finding those who are infected much earlier, allowing doctors to treat most of them in a community setting.

In South Africa, all children receive injectable-free treatments, and in both South Africa and India, MSF has introduced child-friendly formulations of some of the most commonly used medications.

MSF has also ensured that children in the places where the organisation works have access to new, highly-effective TB drugs, and that they can be treated with shorter regimens.

Fortunately for Keitu, a family-centred approach was offered to them at the clinic. She, the baby, and her six-year-old brother were found to be well and were started on preventive therapy.

Her four-year-old brother had been losing weight and his chest X-ray was abnormal. He was started on treatment for DR-TB after a stool sample was collected and the disease was confirmed.

He was able to get an all-oral regimen with dispersible tablets, which his mother gave him each day with yoghurt. In spite of their challenges, the family began to heal and hope returned to their home.

While MSF’s work has benefited hundreds of children and families, there are tens of thousands in need of such innovative approaches. Keitu and her family faced a challenging journey, as do thousands of families grappling with DR-TB every day.

Stakeholder commitment and far greater resources are desperately needed to rapidly increase the scope of these child-friendly initiatives. This is the only way to ensure that families like Keitu’s face a less frightening future when one of their number becomes sick with DR-TB.

To support MSF, visit: https://www. msf.org.za/donate

Cape Times

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