The challenges South Africa is facing with MDR- and XDR-TB are due to the health system’s failure to manage tuberculosis, said Mark Heywood, director of the AIDS Law Project, in a controversial presentation at last week’s TB conference in Durban.
MDR- and XDR-TB are the result of treatment failure of regular tuberculosis, where the infection builds up a resistance to TB drugs. Heywood implied that if the primary TB infection is treated effectively and successfully, it would not develop into MDR- and XDR-infection.
“We will not be able to manage the crisis of TB if we do not sort out the underlying crisis of health systems, of funding for the health system, of human resources, and an array of those issues,” said Heywood.
Why treatment fails
“TB is treatable and yet TB is the main natural cause of death in South Africa. Treatable it may be, but treating people and saving people and curing people, this we are not doing,” said Heywood.
The Department of Health (DoH) estimates that around 8.8 percent of TB patients default on their medication. They hold patients responsible for the failure of treatment as patients are defaulting on their treatment by not taking medication as prescribed, or not taking their medication at all.
This is where human rights come into play, Heywood argues. “What we’ve seen with HIV (where you have the most pronounced human rights response) is that as protective human rights improve, health outcomes improve.
“If we respect people’s dignity, we will get better uptake of health-care services,” Heywood remarked in response to patients’ poor adherence to TB treatment. He called for greater communication efforts to educate patients on this disease and its treatment outcomes.
Humane treatment of patients
It is a public health duty to limit the human rights of a group under certain circumstances to ensure public health safety, Heywood stated with regards to the isolation of MDR/XDR patients.
“But are we limiting human rights in a way that is humane, dignified and reasonable?”
He presented a picture of a TB hospital surrounded with barbed wire and guarded by a security officer and asked: “Why do people want to escape from a hospital?”
He brought to light the fact that while isolated in TB hospitals, MDR/XDR patients are denied social security grants, are locked up in security facilities resembling prisons and have very little or no contact with family.
“We believe it [the isolation of patients] is an inefficient public health policy because it makes people scared of an MDR or XDR diagnosis, which in fact keeps people out of health-care services.”
Failures in the system
Authorities have admitted that in some TB facilities, patients are lumped together with the result that ordinary TB patients are in danger of contracting MDR- and XDR-TB, Heywood said.
He calls for infection-control measures to be implemented in hospitals where these risks exist. “Legally you are required to do it, if that is what it takes to stop people being infected with a fatal illness.”
Heywood also remarked that there is growing evidence of MDR- and XDR-TB infection among health-care workers and asked whether the government is doing enough to prevent transmission in health-care facilities.
- (Wilma Stassen, Health24, July 2008)