South African hospital sending patients with drug-resistant TB home

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Drug resistant tuberculosis is a serious global problem, especially those forms of drug-resistant TB that can fend off multiple types of drugs. Patients with resistant forms of TB are supposed to be treated and monitored to reduce the spread of the disease.

That is not happening in South Africa.

A new study published in the British medical journal The Lancet today shows that South African hospitals are releasing a ” substantial” number of patients with extremely drug resistant forms of TB to their homes.

Given the already poor status of people living with TB in South Africa, the lack of proper care poses a threat to the millions who live in the country. The first case of totally drug resistant TB in South Africa was recorded last year as more and more people with TB are not being cured. It is made worse by the fact that people living with HIV are at a greater risk of catching TB.

The researchers evaluated 500 diagnosed patients from a hospital in Tugela Ferry, located in the KwaZulu-Natal province of South Africa. They followed up on people who were diagnosed between 2005 and 2006. Nearly three out of four people died among the 107 patients that the researchers further investigated.

A worrying number of patients had forms of TB that were resistant to numerous drugs, but it was the discharge rate that capture the most attention. Some forty-two percent of the patients discharged carry transmissible forms of multi-drug resistant TB.

“These patients can survive for months or even years, and are contributing to the community-based spread of XDR-TB,” said study leader Keertan Dheda from the University of Cape Town and Groote Schuur Hospital, to Health 24.

The reason for sending the people home? Not enough beds at the hospital. While focused on TB, the problem is illustrative of larger health systems challenges for South Africa. The inability to accommodate a subset of patients does not bode well for care for people with other health problems.

“Drug-resistant tuberculosis is an acute global health crisis. National control programmes must urgently develop strategies to use existing public health instruments for control of tuberculosis in all its forms. Major new investments in drug development, diagnostics, and operational research are needed,” write Max O’Donnell and Neil Schluger in an accompanying commentary.

The South African government says it is aware of the problem and will increase efforts to cut off the spread of TB. It cited a new $52 million grant for increasing access to testing and treatment, as well as plans to grow the number of nurses nationwide as examples of how the problem will be addressed.

“We realise that the problem here is similar to that experienced in many other parts of the world,”  said Dr Yogan Pillay from South Africa’s Department of Health in a press conference. “But we have a big problem.”

The implications stretch wider than South Africa, say the report authors. Extremely drug-resistant TB is a problem experienced beyond South Africa and in India and parts of eastern Europe. New drugs will be needed to stop the progress of resistant forms of TB.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.