HIV/AIDS can dramatically fuel the rate of tuberculosis (TB) infection. In South Africa, more than 16% of the population are infected with HIV/AIDS, and 1,000 people die from AIDS-related diseases each day. Two-thirds of those with HIV/AIDS also suffer from TB because of their weakened immune systems.
Dangerous drug-resistant strains of TB have now started to emerge. MDR-TB (Mulitidrug Resistant Tuberculosis) describes strains of TB that are resistant to at least the two main first-line TB drugs. XDR-TB or Extensive Drug Resistant TB is MDR-TB that is also resistant to 3 or more of the 6 classes of second-line drugs. XDR-TB leaves patients virtually untreatable using current anti-TB drugs.
In South Africa, 183 people have died from XDR-TB since September 2006. All provinces are affected.
Resistance to anti-TB drugs occurs primarily because of poorly managed TB care. Problems include incorrect drug prescribing practices by providers, poor quality drugs or erratic supply of drugs, and non-adherence. Non-adherence is particularly common - treatment is long and complicated and drugs must be accompanied by nutritious food for 6 months. Many patients fail to stick to the treatment or stop taking it as soon as they feel better.
Community response to TB
In 2002, AMREF was requested by the Department of Health to improve poorly functioning TB services in Sakhisizwe - Chris Hani district, Eastern Cape Province, South Africa. Research had shown that health workers in Sakhisizwe were poorly trained and were failing to apply policies and guidelines for TB management and control. Local communities lacked knowledge of early TB detection and compliance with TB treatment and management.
In response, AMREF and its partners implemented a community-based programme for TB prevention and management in Sakhisizwe. The programme included training community health and development workers in TB awareness and prevention, and on how to administer treatment and take it correctly. It also involved training at least 40 health professionals in TB symptom detection, testing, treatment, monitoring and recording.
By the end of the project, the community’s knowledge of TB had risen from 23% to 100%; adherence had increased and the TB cure rate had risen from 20 to 55%.
Need to integrate HIV and TB services
The project identified an increasing need to integrate the HIV/AIDS voluntary counselling and testing (VCT) and TB services in the area; to build the capacity of VCT service providers to test for TB; and to strengthen VCT referral to TB treatment and support services.
Therefore, AMREF has recently established a new project in South Africa’s Eastern Cape Province. The project aims to strengthen HIV/AIDS voluntary, counselling and testing (VCT) services and to improve the referral system between VCT and TB services. In its first year, the project will train at least 70 staff at existing VCT centres in the links between TB and HIV/AIDS, TB symptoms and TB testing referral. A significant number of community health personnel will be also be taught how to counsel TB patients on need for VCT, and HIV patients on need for TB testing, and to mobilise and motivate patients to go for TB testing.
