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Dealing with drug-resistant tuberculosis in Africa

6 Oct 2008

Paul Chinnock

Citation: Alsop Z. Dealing with drug-resistant tuberculosis in Africa Lancet; 372(9641):793-794

The spread of resistant forms of tuberculosis (TB) is of particular concern in developing countries. TB rates are already high in these countries, often linked with a high prevalence of HIV, and treatment programmes are frequently inadequate.

In South Africa, where multidrug resistant TB (MDR-TB)* was already present, extensively-resistant TB (XDR-TB)* first appeared two years ago in Kwa Zulu Province leading rapidly to the deaths of 52 patients. Health authorities decided on a policy of containment and two provinces have now passed laws allowing the compulsory detainment of patients diagnosed as having XDR-TB. An article in the Lancet discusses the situation, reporting that there have been a number of violent incidents where detained patients have attacked hospital staff in a bid for freedom.

The policy has been criticises by many experts. The Lancet article for example quotes Francois Venter, who heads the HIV Management Cluster at University of Witwatersrand’s Reproductive Health and HIV Research Unit in Johannesburg, as saying: ‘Isolating someone for a brief period, when they have been infectious for a long time, is locking the door long after the horse has bolted. It doesn’t make any sense in scientific or public-health terms.’ Dr Venter instead advocates community-based treatment programmes.

The article reports from Kenya where no XDR-TB has yet been diagnosed, but over 500 patients are known to have MDR-TB. Kenya is unusual amongst Africa countries in that it is attempting to implement a national programme for the treatment of drug-resistant TB. However, owing to a lack of funds the programme so far comprises only a two-roomed tent pitched in the grounds of the Kenyatta National Hospital in Nairobi.

The situation may not be as bleak as some have predicted. The spread of XDR-TB could turn out to be less rapid in Africa than elsewhere, simply because governments have not been able to afford more expensive, second-line drugs, leaving little opportunity for resistance to them to develop. However, this lack of resources – for both diagnosis and treatment – may mean that XDR-TB poses a serious threat to Africa in the long term.

* MDR-TB describes strains that are resistant to at least rifampicin and isoniazid, which are both first-line treatment drugs for the disease. XDR-TB strains are additionally resistant to at least two classes of second-line treatment drugs.