South Africa: Doctors Say It Might Be Necessary to Detain TB Patients

South Africa, where conditions are highly conducive to the spread of extensively drug-resistant tuberculosis (XDR-TB), should consider forcibly detaining patients who refuse treatment for the infection, a trio of doctors is proposing.

Drs. Jerome Amir Singh, Ross Upshur and Nesri Padayatchi made their case in a paper published on Monday. Singh and Padayatchi are at the Center for AIDS Program of Research in South Africa, and Upshur directs the Joint Center for Bioethics at the University of Toronto.

Since September, more than 300 XDR-TB cases have been identified in South Africa, and at least 30 more are reported each month.

South Africa's high prevalence of HIV/AIDS, which fuels the spread of TB, is a particular concern. Social conditions in the country, including a population of migrant laborers and a strong tourism industry, are also factors in XDR-TB's spread.

South Africa routinely suspends social benefits to people when they are hospitalized, causing many patients to avoid treatment. The study authors recommend that XDR-TB patients be paid while in detainment. "If we ask individuals to forgo their rights, they need to be supported," said Upshur.

"The issue of holding the patient against their will is not ideal but may have to be considered in the interest of the public," said Ronnie Green-Thompson, an adviser to the South African Department of Health. "Legal opinion and comment as well as ... the opinion of human rights groups is important."

Dr. Mario Raviglione, director of the World Health Organization's Stop TB department, said it is unknown whether lack of compliance is a factor in the South African cases. Still, he will not rule out involuntary confinement. "We can't put the public at risk of a disease that is almost incurable," he said.

The paper, "XDR-TB in South Africa: No Time for Denial or Complacency," was published in the open-access journal Public Library of Science Medicine (2007;4(1):e50 doi:10.1371/journal.pmed.0040050).

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