November 8, 2010
Treating TB in a country facing dual epidemics of TB and HIV requires careful coordination and experienced staffing on the part of public health programs. Each year, more than 300,000 people with HIV contract TB in South Africa, and 110,000 die of the bacterial lung infection.
TB treatment takes at least six months and requires patients to take multiple pills on a regular schedule each day. The pills' side effects can be debilitating. "Some patients hide the pills because they say it's too much for them," said Themba Grammary, a TB patient in the poor township of Alexandra, north of Johannesburg.
Grammary, who says he feared his neighbors would ostracize him for being HIV-positive, had never sought antiretroviral treatment. But when he developed TB for the second time in early 2010, he finally relented and went to the local health center. "I could not walk. I waited too long," he said. His nurse, Vuyelwa Twalo, said his CD4 count was 24.
Initially, Grammary received daily injections for 40 days. He has since switched to taking five pills daily at the clinic under Twalo's supervision. "We have to make sure that they take the medication at a regular time and don't defect," said Twalo.
If a patient refuses to come to the clinic every day, Twalo tries to send an observer to the patient's home or job.
Patients who abandon their TB treatment can develop drug resistance. In 2008, the World Health Organization reported at least 14,000 cases of multidrug-resistant TB in South Africa.
Christian Lienhardt, senior research advisor for the Stop TB Partnership, said a massive investment in new TB treatments is needed. "We need a treatment that takes two to four months and has less side effects" so that patients complete the regimen, he said.