How KZN is using technology to fight its TB crisis
Durban - The KwaZulu-Natal Department of Health has rolled out a host of new machines and tuberculosis-testing technology in an effort to curb the spread of the disease in the province, which has the highest prevalence in the country and at a rate twice the level of what the World Health Organization (WHO) deems a crisis.
Speaking at a commemorative World TB Day community outreach programme at iLembe on the KZN North Coast on Tuesday, Health MEC Nomagugu Simelane unveiled a new mobile X-ray clinic container able to produce TB results in a record time of 15 minutes.
There are plans to roll out the facility in other parts of the province.
Although the TB notification rate has declined from 1 128 reported in 2010 to 410 per 100 000 population recorded last year, this is more than twice what the WHO declares a crisis (200 per 100 000), noted Simelane.
She said the province had begun implementing the basics of TB diagnosis and treatment by scaling up the use of the GeneXpert Ultra machine, which had been in use since 2019, as a replacement for GeneXpert cartridges.
“This new approach helps us receive results for TB tests in just two hours, which is much quicker than the previous turn-around time of three hours with the previous GeneXpert machine,” Simelane said.
“Long ago, when we were using the microscope to conduct TB testing, we could only pick up about 50% of the bacteria. When the GeneXpert came, this improved to at least 75%; but now with the Xpert Ultra machine, its sensitivity is such that we are able to pick up about 90% of the bacteria. Between January and December 2020, we conducted 885 128 Xpert ultra tests compared to 1 129 443 tests conducted in 2019. The decline is a result of COVID 19, which decreased the number of clients visiting health-care facilities. We will be scaling up our efforts in this regard, so that we are able to meet our targets,” she said.
In addition, the KZN Health Department was also strengthening TB case finding in and beyond health-care facilities to communities through 270 community outreach teams who are spread throughout the province.
As a result of the declining headcount in health-care facilities, these community outreach teams are integrating Covid-19, TB, HIV and non-communicable screening and testing during their visits to people’s homes.
“This is yet another example of the effectiveness of the Primary Health Care approach, which is a critical part of National Health Insurance,” Simelane said.
Her department had been focusing on TB prevention for people living with HIV, particularly through earlier initiation and scaling up of antiretroviral therapy.
This has been done while also scaling up continuous TB preventive therapy by introducing the 3HP approach, Simelane said.
This new 3HP therapy, which begins next month in eThekwini, is a shorter regimen that is taken twice a week for three months.
It will replace the six-to-12 months INH therapy, which has been used up to this point.
She said a new drug called Delamanid, which was introduced in April 2019, has been quite effective in treating extensively drug-resistant tuberculosis (XDR-TB) patients.
“It has fewer side effects and is more effective on XDR patients. To date, 350 XDR-TB patients have been initiated on this medication. KZN has a TB/HIV co-infection rate of 61%, which makes diagnosing TB quite challenging. However, we have introduced a urine LAM TB test, which is extremely helpful in the diagnosis of people who are too sick to produce sputum and have a CD4 count of less than 200. It is less invasive,” Simelane said.
An average of 500 patients per quarter in the province are diagnosed through this test, with a high positivity yield of 22%, and patients are promptly initiated on treatment.
The test is currently available in all hospitals and community health centres, and plans are under way to roll out the test in large primary health-care clinics.
Despite the challenges, including the high burden of TB and HIV, Simelane said KZN has maintained a TB treatment success rate of 79%, with a loss-to-follow rate of upwards of 9% and a death rate of 8%.
Late presentation of patients has also been highlighted as one of the challenges resulting in a high death rate. To mitigate this and ensure continuity of care, the department has call centre agents whose job is to track and trace patients who do not honour their treatment follow-up appointments.
“However, we will continue to scale up our efforts to educate and encourage the public about the importance of screening and testing for TB. Robust and innovative methods for active TB case finding are also being tested, such as the digital X-ray screening in eThekwini, which is the epicentre of TB in the province,” she said.