South Africa Tries Treating TB Patients at Home

In the township of Khayelitsha, near Cape Town, health authorities have teamed up with Doctors Without Borders (DWB) on a pilot project to care for patients with drug-resistant TB at home instead of under forcible confinement.

South Africa has one of the world's highest TB rates due to its HIV/AIDS epidemic. HIV weakens the immune system, making those infected more vulnerable to TB. Many patients stop taking TB medicines before their treatment regimen -- typically six months or longer -- is completed, causing the development of drug-resistant strains. South Africa saw drug-resistant TB cases jump from 6,000 in 2002 to 14,000. Khayelitsha had around 200 cases of drug-resistant TB last year in a population of half a million, though health experts believe the true figure is much higher.

Currently, government policy is to place drug-resistant TB patients in isolation hospitals surrounded by barbed wire and guards for the roughly two years it takes to treat such TB strains. Eric Goemaere, medical coordinator for DWB in South Africa, said this plan is unrealistic given the sheer number of patients. It is also unfair to patients, he said.

"What we are piloting [in Khayelitsha] is the best compromise to give some decency and respect to patients who are facing this terrible illness," said Goemaere.

Under the government-sanctioned project, health workers are specially trained to treat patients in the home environment; all family members are screened for the disease; and everyone is required to be meticulous about wearing a face mask. Initial results have been encouraging, with an increase in the number of TB cases diagnosed and in patients adhering to treatment, said Virginia Azevedo of the Cape Town health department. The project is expected to run for at least another two years.

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