South Africa tries treating TB patients at home

March 23, 2009 By CLARE NULLIS , Associated Press Writer

(AP) -- South Africa is trying a new approach to controlling drug-resistant tuberculosis - treating people at home rather than in isolation hospitals surrounded by barbed wire and baton-wielding guards, health officials said Monday .

South Africa has one of the world's highest rates of TB because of its AIDS epidemic. People with HIV are more likely to contract tuberculosis because of their weakened immune systems.

Existing policy is to forcibly confine patients with drug-resistant TB for around two years.

But health authorities in Cape Town said that this is unrealistic because of the sheer numbers of patients. They have joined with the charity Doctors Without Borders, also known as Medecins Sans Frontieres, on a pilot project to care for people at home.

"What we are piloting here is the best compromise to give some decency and respect to patients who are facing this terrible illness," Eric Goemaere, medical coordinator in South Africa for the charity told reporters.

The poor suburb of Khayelitsha, where the pilot project is taking place, has 1,500 cases of TB per 100,000 people - nearly four times the level classed as an emergency by the World Health Organization.

Many people tire of taking TB drugs for the necessary six months before the disease is completely cured and this has led to the explosion in the drug-resistant strain which has increased from 6,000 in 2002 to 14,000.

Goemaere said that health workers had detected around 200 cases of drug resistant TB last year in Khayelitsha, which has a population of half a million, but said the true figure was much higher.

"We only know about the tip of the iceberg," he said.

Given the sheer numbers involved, prolonged hospital confinement is simply unrealistic, according to Goemaere. Far too many people die while waiting for a bed and to get on to treatment. Even more die before they are diagnosed as being sick.

There have been regular incidents of patients staging violent attempts to break through cordons of security guards at two of South Africa's most notorious hospitals. Some patients have succeeded in absconding and have been hidden by their families, prompting police to stage door-to-door searches. Staff are reluctant to work on the wards, saying the patients have attacked them and constantly threatened to spit their infectious germs into their faces.

But treatment at home is far from straightforward. All family members have to be screened for the disease and health workers specially trained, and people have to be meticulous in wearing a face mask.

Virginia Azevedo, a doctor with Cape Town's health department, said there had been some cases of children infected by a family member being treated at home but it was too early to draw conclusions.

The pilot study - which has the blessing of the national government - is expected to run for at least another two years. But initial results have been encouraging, with an increase in the number of TB cases diagnosed and an increase in patients sticking to the treatment, according to Azevedo.

Busisiwe Beko, 35, was diagnosed with drug-resistant TB in February 2006 and discovered that she had infected her infant daughter. Beko, who was also infected with HIV, like many TB sufferers, was put on a waiting list for a hospital bed.

"I felt that if I went to hospital ... I would go and die in there," she said.

By then she was desperately ill and so started treatment for both the drug-resistant TB and AIDS at home, wearing a mask to prevent her from infecting her family and keeping windows open to ensure maximum circulation of fresh air.

She said support from her loved ones helped her survive six months of painful daily injections and 18 months of "horrible drugs" that made her vomit daily.

"You can get cured, that is the message I am spreading," said Beko, who is now a counselor with Medecins Sans Frontieres.

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