MDR-TB Role Players to debate best practice solutions at Lilly MDR-TB partnership

Optimising the decentralisation of MDR-TB treatment as well as maximising reporting and advocating efforts to scale up models of care in the fight against drug-resistant TB will be the primary focus at a three-day conference coordinated by Lilly South Africa and the National Department of Health from 17-19th March, 2015.

Under the banner of the Lilly MDR-TB partnership, representatives from the national and provincial departments of health, various NGOs and healthcare facilities, as well as academics will gather to share best practices and debate the challenges of treating South Africa’s growing burden of multi-drug resistant and extensively drug resistant tuberculosis (MDR-TB and XDR-TB).

“The conference is designed to unpack challenges as well as successes and best practices from provinces across the country, and how best to implement the optimal means to diagnose and treat MDR-TB patients. Over the years there have been a number of successes, but equally so many challenges still remain and there are lessons from past experience that we need to share and build from if we are to win the war against drug-resistant TB,” says Dr Norbert Ndjeka, head of the National MDR-TB directorate at the National Department of Health.

South Africa has the sixth highest burden of TB in the world after China and India – almost 1% of the South African population gets active tuberculosis every year. While the number of TB patients initiated on treatment under the National TB Programme appears to be decreasing over the last four years, the number of multidrug-resistant TB (MDR-TB) cases is escalating.

“We face many challenges in the fight against MDR-TB. Before approval of decentralised management of MDR-TB policy, we had several challenges including the fact that: nearly half of people diagnosed with MDR-TB would not be started on treatment for various reasons, including months of waiting for admission to treatment facilities and the onerous demands on patients in terms of transport to treatment centres for follow-up. There was also a significant negative impact on the social and economic status of the individual and family due to the long hospital stay, risk of transmission in hospital due to inadequate implementation of infection control measures, and non-uniformity in the current, sporadic efforts of decentralised management.

Drug-susceptible TB is usually treated with a six-month course of medicines , however drug-resistant strains often require more medicines and can take up to two years to treat successfully. We have to find better ways of treating TB if we are to improve treatment outcomes for people with DR-TB,” adds Dr Ndjeka.

Decentralisation of care

“We are working hard to strengthen the decentralisation of MDR-TB services and policy implementation is well underway in this regard. Monitoring and evaluation of the facilities and outcomes are critical and various tools are in place to achieve these. Our target is to have one MDR-TB treatment initiation (decentralised) site per district by 2016 and to strengthen community MDR-TB care. Last year only 38 districts had at least a MDR-TB treatment site, while 14 districts did not have any form of MDR-TB treatment initiation site.

The number of treatment sites had increased from 11 to 63 between the year 2011 and 2013.

“To date there are 298 MDR-TB treatment initiation sites, 272 satellite sites, 150 injection teams and five Nurse-initiated MDR-TB sites countrywide. Only two districts do not have a MDR-TB treatment initiation site,” says Dr Ndjeka.

In order to support and advance the decentralisation process, nurse initiated MDR-TB has been endorsed. Applying the aforesaid model will provide the opportunity for increased capacity in a setting that has few doctors to initiate. Decentralisation of MDR-TB services in the field translates into three main models: in-patient decentralised care, ambulatory decentralised care and outreach care.

“Extensive training is going into upskilling nurses as MDR-TB initiators. We are also aiming to have treatment linkage officers in each district to help us close the gap between number of people diagnosed and number of people initiated on treatment.”

“We have to train our human resources to handle treatment effectively outside of centralised treatment centres. The best way to beat TB is to prevent its spread through early suspicion, faster diagnosis and early initiation and completion of the appropriate treatment. We need patient-centred services where individuals can access treatment closer to their homes, and much faster,” concludes Dr Ndjeka.

The Lilly MDR-TB Partnership conference with the National Department of Health takes place from 17-19 March 2015 at the Birchwood Hotel on the East Rand.

The Lilly MDR-TB Partnership is a public-private initiative to address the expanding crisis of multi-drug resistant tuberculosis (MDR-TB) and includes partners such as the Department of Health, the Donald Woods Foundation, DENOSA, FHI 360, King Dinuzulu Hospital Complex, the South African Medical Research Council and the KwaZulu-Natal Chapter of the South African Red Cross. It has been active since 2003 and Lilly has worked with the national Department of Health to develop a holistic project strategy that is aligned with its TB Strategy.

The partnership has implemented community level programmes to raise awareness about MDR-TB, increase access to treatment, support people along their treatment journey and empower people and communities by eliminating the stigma of the disease. The partnership also trains health care workers to recognise, treat, monitor and prevent the spread of MDR-TB.

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Media interviews:If you would like to interview Dr Ndjeka from the Department of Health or Amy Israel from Lilly, please contact Anne or Teresa on (011) 894 2767 or e-mail anne@tscommunications.co.za to make the necessary arrangements.