DRUG-RESISTANT TB in SOUTH AFRICA: Issues & Response

1. _ ______ _____ ___ __ __ __ __ __ _______ ___ ________ ___ _______ _________ __ _____ DRUG-RESISTANT TB in SOUTH AFRICA:Issues & Response Dr. Norbert Ndjeka MD, DHSM (Wits), MMed(Fam Med) (MED), Dip HIV Man (SA)Director Drug-Resistant TB, TB and HIVNational Department of Health

2. BURDEN OF DISEASE: TB • WHO estimated 1% of the population gets TB annually (490,000) • 410,000 notified in 2009 • RSA 3rd high burden country after India and China (WHO Global Report on TB Control, 2009) • RSA is the 5th high burden country globally for DR-TB with an estimated: • 13,000 (WHO Global MDR TB Report, 2010)

3. MDR-TB DIAGNOSIS IN THE PUBLIC SECTOR IN SOUTH AFRICA

4. Factors associated with MDR-TB • Defaulting drug-susceptible TB treatment • High levels of transmission in the communities • Socio-economic: poverty, overcrowding, malnutrition, alcohol abuse, smoking • Medical: HIV, diabetes and other chronic diseases that reduce immunity • Occupational: working environment which is high risk for TB transmission both in public and private sector

5. PERFORMANCE OF TB PROGRAMME: CURRENT • Increasing incidence of TB • High TB/HIV co-infection rates • Poor treatment outcomes for new smear positive patients • Cure rate: 68% (target = 85%) • Defaulter rate: 8% (target less than 5) • Death rate: 8% • High retreatment rates with even poorer treatment outcomes • Cure rate: 54% • Defaulter rate: 13% • Death rate: 11%

6. DRUG RESISTANT TB • Increasing incidence of MDR-TB • Almost 50% of diagnosed MDR-TB cases (9000) in 2009 lost before treatment initiation, 4143 were started on treatment. • With 3334 patients started on MDR-TB treatment during the year 2007: • Poor treatment outcomes for MDR-TB • Treatment success rate (2007): 42% • One out of 5 died on treatment, 1/5 still on treatment • At least 1/10 defaulted treatment

7. Key issues about MDR-TB treatment • Treatment duration: averaging 24 months • Follow up after 24 months required every 6 months for another 24 months • Treatment is very costly: R 1500 per month (200US dollars) for MDR-TB and at least 4 to 5 times more per month on a XDR-TB patient (800 to 1000 US dollars/month/XDR-TB) • MDR-TB patients are infectious. When should they be allowed to go back to work?

8. KEY CHALLENGES • Limited involvement of the private medical sector in providing MDR-TB services • Cross-border issues around migrant labourers • Inadequate support of MDR-TB patients in the working environment leading to job losses, treatment default • Poor treatment outcomes • Inadequate ACSM (advocacy, communication and social mobilization) • Stigma • Poor understanding and awareness about MDR-TB • Lack of community involvement

9. REQUIRED RESPONSE: SCALE UP ACCESS • Intensified case finding in HIV positive and comprehensive management of people co-infected with HIV • Early diagnosis: by increasing access to new quick & effective diagnosis such as molecular assays • Early treatment through decentralization of MDR-TB care • Strengthening the implementation of the DOTS Strategy • ImproveTB Infection Control in the workplace and residential areas

10. WHAT CAN BUSINESS DO TO ASSIST? • Update workplace policies to include: • Support MDR-TB patients by special considerations for extended sick leave and providing treatment support as well as psycho-social support for employees, workplace modification • Conduct workplace education and awareness campaigns • Address stigma and discrimination

11. WHAT CAN BUSINESS DO TO ASSIST ? (2) • Implement infection prevention and control in the workplace • Provide effective occupational health services • Support Government initiatives to address poverty and unemployment as part of social responsibility programmes. • Support ACSM initiatives on TB and HIV

12. THANK YOU! WE ARE ON THE MOVE TO KICK TB OUT!!!