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Half of drug resistant TB patients die waiting for diagnosis

DURBAN - KwaZulu-Natal was making huge strides in controlling multi-drug resistant (MDR) TB and extensively-drug resistant (XDR) TB, but a staggering 50 to 60% of patients were dying while they are awaiting diagnosis which takes between four and six weeks.

A further 15 to 20% of the remaining patients were lost to follow-up.

Bruce Margot, chief technical officer for communicable disease at the KwaZulu-Natal health department, told a breakfast session at the 4th South African AIDS Conference that they were making inroads in detecting MDR TB and XDR TB and had instituted aggressive case finding since the Tugela Ferry XDR outbreak in the Msinga sub-district three years ago.

“There are problems getting them onto treatment and part of the explanation is that from the time we take the specimen until they are diagnosed, 55% of patients have already died. By the time we realize what we are dealing with, they’re gone,” Margot said.

“It’s simply a delay in getting diagnosis which takes four to six weeks,” he said. TB diagnostics are outdated and there is a new drive to find methods to speed it up.

Margot said they were not “throwing a party yet in Msinga”, but that the MDR and XDR cases had dropped significantly. In 2005 64 MDR TB cases were diagnosed in 2005, jumping to 122 patients in 2006 with 60 recorded for 2008. XDR was diagnosed in 114 patients in 2005, 116 in 2006, 146 in 2007 and down to 69 in 2008.

Margot said further studies conducted in 18 hospitals showed that the XDR problem was not “massive” in the province and that the outbreak in Msinga may have been isolated.

He added that a community-based care programme piloted in Msinga was showing promise and that the province had no choice but to decentralize MDR treatment to the district level with patients treated at home after an initial period in hospital. The province has experienced a consistent shortage of more than 100 MDR beds with patients waiting between two and four weeks for a bed at King George V Hospital.

“We have found it, we have acknowledged it and we are starting to deal with it while many others are simply not looking at it,” Margot said.

Dr Igbal Master of King George V Hospital said the beds would never be enough and that an outpatient system made sense. He confirmed that “most patients die before they get to us” while another 33% die after arriving.

Master also revealed that they had seen an increase in drug-resistant healthcare workers being sent to King George V for treatment – 80 in 2007 and 63 in 2008. Master said they also had an erratic drug supply which had to be addressed.