GroundUp (Cape Town)

South Africa: Activists March for State to Improve TB Diagnostic Procedures

Civil society organisations led by the Treatment Action Campaign marched on 22 March to an event addressed by Health Minister Aaron Motsoaledi at a school in Khayelitsha in anticipation of World Tuberculosis (TB) day.

The marchers handed over a memorandum explaining that a recently developed TB diagnosis machine called the Gene Xpert can only make a difference to the treatment of TB if it leads to patients being started quicker on treatment. In order for this to happen, the memorandum stated, there needs to be an uninterrupted supply of the cartridges used in the machine. Clinics also need the resources to treat drug-resistant TB.

Several thousand people are diagnosed with drug-resistant TB in South Africa every year. This form of the disease is very difficult to treat and has a high death-rate.

The Minister was speaking at a ceremony at the Ludwe Qamlana Primary School in Kuyasa. Addressing a crowd of primary school learners, government officials, activists and parents he pleaded with parents and care workers to be vigilant in looking for the symptoms of TB in children, because the disease can be hard to detect in them.

2000 soccer balls listing the symptoms of TB were given to learners. This was to make it easy for children and parents to remember the symptoms of TB explained Motsoaledi. "One person with TB can infect twenty people in a year if not treated. TB is not an individual problem but a community problem," he said.

Motsoaledi told the audience that South Africa's slow TB diagnosis system had been replaced by the Gene Xpert which takes only two hours to diagnose patients with TB. He further stressed that the machines won't help if people are not accessing the service.

The Gene Xpert comes with challenges. The smallest machine costs over R100,000. Each patient test requires a cartridge costing about R90. It often fails to diagnose TB in patients with HIV whose disease is quite far advanced. Nevertheless, it is better than the previous standard of care, still used in many places, which involves trying to find TB using a microscope, a tedious, highly-skilled and error-prone process.

The Minister also made an appearance at Pollsmoor prison on Sunday 24 March. He promised steps were being taken to ensure that every prisoner would be screened for TB. Minister of Correctional Services Sibusiso Ndebele also attended and said that tremendous strides have been made in the general inmates admission procedures and that his department had asked the Department of Health to help Correctional Services develop guidelines to prevent TB in prisons. The Department of Health has recently released guidelines for treating TB in prisons.

Last year, the Department of Correctional Services lost a court case against Dudley Lee, a former awaiting trial prisoner who spent four years in Pollsmoor before being acquitted. Lee became ill with TB in prison. The Constitutional Court ordered that the state must compensate Lee. The TAC joined the case as a friend of the court. The organisation generated publicity around the case that put the spotlight on how high TB transmission rates are in prisons and put pressure on Correctional Services to improve the management of the disease. A study in the South African Medical Journal, published after the Dudley Lee case was heard initially in the Cape High Court, used the facts that came out of the case to show, using a mathematical model, that an awaiting trial prisoner who has spent a year in Pollsmoor has about a 90% chance of becoming infected with TB.

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