Johannesburg — SA HAS made progress in controlling and curing tuberculosis (TB) since experts from the World Health Organisation (WHO) visited the country in 2005, but after their visit last week they said a greater emphasis was needed on patients with HIV, who are susceptible to TB.

Staff from the WHO , the US Agency for International Development , the Stop TB Partnership and the Foundation for Innovative Diagnostics (Find) observed TB treatment and management in SA last week.

The experts' review included observations of the provision of care in clinics and hospitals, interviews with TB service managers and health workers.

They looked at TB and HIV co- infection, multi-drug resistant TB (MDR-TB) and extreme drug resistant TB (XDR-TB) and public- private partnerships .

Giorgio Rosigno, the CEO of Find, said SA had excellent TB- testing facilities and a capacity to produce new drugs.

"We are looking at the country as a pool of innovation and we hope that it will share experience with the rest of the continent."

The TB defaulter rate -- patients who stop taking their medication prematurely -- had declined and the cure rate increased.

Dr Norbert Ndjeka, director of TB and HIV control at the Department of Health, said the number of MDR-TB and XDR-TB patients was low. Departmental statistics showed that the number of MDR- TB patients in the first quarter of this year went down to 1128 from 3757 in 2007, while XDR-TB went down to 113 from 493 in 2007.

The defaulter rate for MDR-TB went down to 93 from 387 and for XDR-TB to six from nine .

Rosigno said SA had an important role to play in the global fight against TB, and there was room to improve the global partnership.

The review team found there had been major improvements in the quality of, and access to, diagnosis and treatment of TB available at health facilities -- resulting in increased case detection and treatment success.

They also found that human resource capacity in TB control was sufficient in some provinces, while drugs were generally available and in sufficient quantities.

The experts recommended that weak infection control measures -- active surveillance of HIV/TB infection -- be improved. Nongovernmental organisations working on HIV should also work on TB.

"HIV testing for TB patients had increased beyond 90% in many of the visited facilities. There should be management of TB/HIV co-infected patients at the same facilities with effective infection control measures."

The team said despite the progress , 1% (about 461 000) of the general population still got sick with TB every year, driven by the HIV epidemic. Ndjeka said about 60% of TB patients were cured every year, while 7% died from TB/HIV co-infection.

Leopold Blanc, from WHO Stop TB, said despite the areas of concern, "we are encouraged by the progress made in this regard. It is, however, vitally important that you look more closely (to) aggressively addressing TB/HIV co- infection and TB within HIV programmes and infection control".

Infection control should be strengthened through the formation of national and provincial infection committees and assigning this responsibility to dedicated persons, Blanc said.

Health Minister Aaron Motsoaledi expressed confidence in the ability of the health system to respond to the TB pandemic even in the context of HIV and AIDS.

"Moving forward, we have to strengthen around the areas that the review draws our attention to," Motsoaledi said.

- Meanwhile, six medical experts from the universities of Stellenbosch and Cape Town wrote last month that a class of antibiotic called aminoglycosides and capreomycin were effective in treating MDR-TB, but these drugs had known dose-related adverse effects. The experts wrote in the South African Medical Journal patients might risk permanent hearing loss .

Ndjeka agreed that hearing impairment, including permanent hearing loss, had been documented around the world after the injection of aminoglycosides and capreomycin.

But "there are no better drugs than these injectable agents, hence the benefits of using them outweigh the risks", he said.

Of the five drugs -- aminoglycosides, capreomycin, kanamycin, Amikacin and ofloxacinused -- used in treating MDR-TB, kanamycin, amikacin and ofloxacin were the strongest components .

"That is why kanamycin or amikacin are used during the injectable phase of MDR-TB treatment around the world, not just in SA," he said.

The experts said aminoglycosides were known to persist in inner-ear tissue for six months or longer after they had been administered. "These drugs appear to generate free radicals that trigger (the) deaths of sensory cells and neurons.

"SA is therefore potentially facing the risk of a significant proportion of the population acquiring aminoglycoside-induced permanent hearing loss," they said.

Ndjeka said it was recommended that all MDR-TB patients receive audiological tests before, during and up to six months after receiving an aminoglycoside injection. " If hearing impairment is diagnosed early, precautions may be taken to prevent irreversible hearing loss," he said.