The Gauteng Health Department says decentralising TB treatment will help address the number of treatment defaulters the province currently has.
About 56 000 people were tested positive for TB last year in Gauteng and 45 percent of them successfully completed their six month treatment programme. The remaining 55 percent is unaccounted for. The province also has a high defaulter rate of patients who have Multi-Drug Resistant (MDR) TB.
Currently, MDR patients in Gauteng are treated at Johannesburg’s Sizwe Hospital as in-patients. This is the only centre that treats MDR-TB patients in the whole province. But some flee the centre and don’t remain for the entire six-month treatment programme.
“We are only using one centre, that is, Sizwe Hospital to treat them and some end up absconding because they have to stay for six months. They end up losing their jobs, they lose their families, so they choose to run away and we lose them in our system. We do not have enough people to do MDR tracing. It is not many patients but, still, it is worrying because we do not know whether or not they are cured since they are out there in the community. That means we should then be worried about the safety of the population as a whole”, says Dr Dimakatso Moloi, chief director for TB in Gauteng.
Moloi says the province recorded about 1 000 treatment defaulters last year. The Health Department has now decided to open smaller facilities inside hospitals to treat MDR TB patients to directly address the issue. This has the added benefit of being closer to their families.
“Family members sometimes think if they are sent to Sizwe Hospital they are going to die. They refuse to be admitted there because of the perception. We have a decentralised model whereby we will start opening small sections in hospitals and clinics and train doctors because MDR (TB) is a very complicated programme - not all doctors know how to manage it. If there is space in a hospital, then we will open a few beds. Rather than sending them to Sizwe, we admit them closer to home. We hope this will encourage patients to stick to their treatment. They will even be nearer home for relatives to visit”, says Dr Moloi.
Head of the Pulmonology unit at Chris Hani Baragwanath Hospital, in Soweto, Professor Michelle Wong, says decentralisation has two implications. Greater infection control measures need to be employed in health facilities and there also needs to be closer monitoring of patients.
“This brings into focus the importance of infection control when you’re having patients in the community and in hospitals with potentially serious infections for which we have limited drugs to treat. Whilst I understand why they are doing it, it does also mean that we have to be more vigilant and ensure that patients comply with treatment because MDR (TB) treatment is quite difficult, very prolonged – (it) can be 18 months to two years. The drugs are many - more than the usual TB treatment with much more side effects. We really need to have a close follow up so that patients do not default on their treatment”, says Professor Wong.