SA Pushed For First Ever TB Summit At The United Nations

Simphiwe holds his medication, he takes up to 26 pills a day to treat XDR-TB. Here he holds his morning selection, which includes delamanid, one of the newest DR-TB drugs, which Simphiwe is taking for the first time today. Simphiwe Zwide, 43 years, lives in a one-bedroom house with his wife, Nomonde Tyala, and children in Kuyasa, Khayelitsha. Simphiwe was first diagnosed with MDR-TB in 2011. He completed six months of treatment, but when he learned that he had pre-XDR-TB and would need even more treatment, he lost heart and returned to work. In June 2016, he presented back to his Khayelistha clinic as he had fallen ill again. This time test results showed he had XDR-TB. He took his first delamanid tablets on 12 October, as part of a strengthened regimen for XDR-TB. Simphiwe’s current regimen: Delamanid, bedaquiline, linezolid, levofloxacin, terizidone, clofazimine, ethionamide Simphiwe Zwide: “In 2011, my wife had TB and they admitted her into Jooste District Hospital. I visited her for over a week. When she came out of hospital, I fell sick. I couldn’t eat, my body was painful, my throat was sore – I thought I had a virus. My wife tried to cook – sour milk and maize meal. I couldn’t swallow. I had to drink many cups of water. I was sweating – I couldn’t walk even couple of metres. My wife was very supportive of me. She would leave me taxi money and go and stand in the hospital queue for me from 5am. I started to feel my health returning and I felt like I could work again. I’m the breadwinner, and we were all suffering. I was the only one who could work for my family. I was taking clofazamine injections which meant that I had to attend the clinic every day and this was preventing me from finding a job. I was between Johannesburg and Cape Town looking for work between 2012 to the end of 2016. Then in January 2016, I started to get sick again. I couldn’t work like I’m used to. I came back to Khayelitsha, now I’m here at Kuyasa clinic g

The 73rd United Nations General Assembly (UNGA) is currently taking place in New York. Various heads of states, ministers and activists have been meeting to discuss the current problems which are facing the world. One important event that will be happening at UNGA is the first ever High-Level Meeting (HLM) on Tuberculosis. The South African government have been instrumental in getting this meeting. The Daily Vox team takes a further look.

The meeting will take place on September 26 and came about because of the actions of minister of health Aaron Motsoaledi. Writing for health news publication Bhekisisa, Motsoaledi outlined how the meeting came about. The meeting takes place under the theme “United to end TB: An Urgent Response to a Global Epidemic.”

In 2001, the World Health Organisation (WHO) established an organisation called the Stop TB Partnership Board. The board was supposed to be responsible for implementing policies around the programmes which were fighting TB. In 2016, in his capacity as the chairperson of the programme, Motsoaledi was invited to participate in a HLM meeting on antimicrobial resistance.

Motsoaledi writes he found it concerning that the UN would discuss antimicrobial resistance and yet would not talk about TB. It was the South African mission to the UN led by ambassador Jerry Matjila who then mobilised various countries to support this call for the meeting which took place.

In June, this year the South African government held the 5th TB Conference in Durban, KwaZulu Natal. The focus of that conference was on tracking the missing TB patients. Deputy President David Mabuza said the undiagnosed TB person constitutes a mobile and invisible infectious pool of people that unknowingly spread the disease to others including children.

SA’s 5th TB Conference Focuses On Tracking Missing TB Patients

 

The declaration commits to providing diagnosis and the successful treatment of 40 million people with TB from 2018 to 2022 including 3.5 million children and 1.5 million people with drug-resistant tuberculosis. Other commitments include better research, sustainable funding and better strategic plans and collaborations to fight the disease.

The declaration states that the heads of states and governments who are gathered at the UN will at the UN reaffirm their commitment to end the TB epidemic by 2030 in line with the Sustainable Development Goals (SDGs). Additionally they pledge to accelerate national and global collective actions to fight the preventable and treatable disease. The declaration also recognises that TB affects populations in-equitably with those living in poverty and with ill-health are at the greatest risk of the spread of TB.

Many things were left out of the final draft of the declaration including national targets for high risk populations such as prisoners, miners and children, timelines for new innovations such a pill-based regimens for TB. Other things that were left out include an independent accountability mechanism outside the UN system to ensure future engagements by heads of states.

According to the WHO, TB is the top infectious killer in the world. In 2017 alone 1.6 million people died from TB including 300 000 people living with HIV. (Human-Immunodeficiency Virus) TB is the leading killer of people with HIV. Additionally, in 2017 10 million people fell ill with TB. from that number 6.4 million people were officially recorded by national reporting systems while 3.6 million people were detected but not reported. The WHO has said that better reporting,diagnosis and access to care will close that gap.

The report found that the geographical disparity of TB was very wide with over 500 cases per 100 000 people found in countries like South Africa, Mozambique and the Philippines. While on the other hand in high-income countries, there were fewer than 100 cases per 100 000 people.

During the release of the Global Tuberculosis Report,  earlier in September, the WHO revealed that countries are not doing enough to end TB by 2030. The report showed the around the world, the number of cases of TB were falling too slowly to be able to meet the targets set by the WHO’s End TB Strategy.

Doctors Without Borders (Medecins Sans Frontieres-MSF) says while they commend the South African government on their actions they have taken to fight TB, much more needs to be done. MSF have called on the South African delegation to declare ambitious national targets to reduce TB mortality within five years.

“78’000 people in South Africa died of TB in 2017, and while this is fewer than estimated for the previous year TB treatment coverage remains low at 68%, meaning that up to one third of all people living with TB are being missed. New case finding strategies are required to ensure that all those with TB are identified and placed on treatment quickly,” said Dr Amir Shroufi, medical co-ordinator for MSF in South Africa.

MSF have also called on the government to commit to mobilising scientific communities and to increase funding for TB research and development. Additionally they want a commitment that the government will use all available mechanism to ensure equitable and affordable access to medicines to fight TB.

“South Africa has done well to improve the DR-TB treatment regimen for adults and adolescents, but new strategies are urgently needed for ensuring that younger children have access to better treatment. This situation would be improved in the very short term by the registration of delamanid, which has proven to be safe in the paediatric population,” said Dr Justine Fargher, MSF DR-TB doctor in Khayelitsha.

Featured image via Simphiwe Zwide and MSF.

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