Technology improves fight against TB

Written by Yazeed Kamaldien

Technology could have saved Cecilia her job and the trouble of taking the wrong medication for tuberculosis (TB) after she was misdiagnosed at a public clinic.

Cecilia, who chooses not to reveal her surname, because she has not told some family members she is on drug treatment, was infected with TB. But the Cape Town resident was diagnosed incorrectly two years ago.

“I was working at the time when I went for the TB test. When we found the results the nurse said I needed to stop working for a while. I didn’t work for about a year,” recalled Cecilia.

“I had about six months of the injection. I went to the clinic every morning. After that I just took tablets. Now I’m on my last month of treatment.

“The problem is that the clinic told me six months later that I have multi-drug resistant (MDR) TB. If I had known I had MDR I would not have to take months of the wrong medication. It would have cut down the time of treatment.”

Traditional TB testing in a local laboratory. Picture by Yazeed Kamaldien

Traditional TB testing in a local laboratory. Picture by Yazeed Kamaldien

She added: “I had no energy left when I found out that I had MDR. I had to start everything all over again. For the six months the side effects were really severe.”

Cecilia is likely not a unique story as traditional TB testing – placing a sputum sample under a microscope – picks up only 50% of cases. If TB is not picked up, it takes another two to six weeks of further laboratory testing to confirm whether a person is infected.

The situation has changed for many patients though as the national health department this year started distributing a machine called GeneXpert to various public health facilities.

GeneXpert cuts TB testing from a few weeks to three hours. Patients can be tested on site and treated much faster. Instead of using a microscope, sputum is placed in a cartridge and the machine detects TB bacteria.
It employs genetic testing instead of traditional methods. It can also confirm whether someone has mutli-drug resistant TB, thus allowing for the correct treatment to be administered.

Sputum samples are viewed under a microscope in traditional TB testing. Picture by Yazeed Kamaldien

Sputum samples are viewed under a microscope in traditional TB testing. Picture by Yazeed Kamaldien

National health minister Aaron Motsoaledi confirmed earlier this year that South Africa “was the very first country on this continent to unveil the GeneXpert technology”.

“We have distributed 242 GeneXpert units around the country. This constitutes 80% of all facilities we would like to cover,” said Motsoaledi.

GeneXpert is a machine that does genetic testing for TB and cuts down the waiting time for results. Picture by Yazeed Kamaldien

GeneXpert is a machine that does genetic testing for TB and cuts down the waiting time for results. Picture by Yazeed Kamaldien

This technology had been used in a limited quantity for trial run at some facilities, including in the Western Cape.

Darren Francis, spokesperson at the Western Cape health department, said the equipment had been available only in some provinces. It was now available in all nine provinces.

“This (GeneXpert) test gives a result much faster than conventional testing. The time from testing to initiation of treatment in drug resistant TB has decreased from 54 days to 9 days. There has been great success in preventing further spread of the disease,” said Francis.

Dr Kerrin Begg, a healthcare consultant with the National Pathology Group, which represents private pathology companies in the country, said early TB diagnosis was vital.

Sputum is placed inside a GeneXpert cartridge and tested for TB. Picture by Yazeed Kamaldien

Sputum is placed inside a GeneXpert cartridge and tested for TB. Picture by Yazeed Kamaldien

Motsoaledi said his department’s database shows “we 405,000 families in South Africa who have a member diagnosed with TB”.

He said Statistics South Africa has found that “TB was the number one killer in the country – not surprising given the synergistic relationship between TB and HIV and Aids”.

TB was also “listed as one of the top five causes of (children) under-5 mortality”.

Motsoaledi said the department had set itself an 85% cure rate for TB, up from last year’s recorded cure rate of 75,9%.

Begg said treatment for normal TB takes six months; for drug resistant TB it is 18 months. If test results are not available soon, she said, “patients get lost and don’t return to the clinic”.

“They are walking around and coughing on everybody, likely spreading TB. So it’s good for the patient if we can diagnose faster. We can cut out the six-week wait for some. The patient could be walking around and infecting others,” said Begg.

“Sometimes patients go on treatment and months later it is discovered that they have drug resistant TB. We can now also know you have resistance and you can use drugs for that immediately.”

She added: “The cost is not related only to testing. It’s also related to the individual and society. People in poorly paid jobs can be replaced and lose their income. The faster we can diagnose and treat, the faster they can get back to work.”

Dr John Douglass, chief executive of Pathcare laboratories, said the private healthcare sector has been using genetic testing equipment for a few years. They have done testing for various large companies and private doctors.

“It costs the patient and the country less. If you attack a disease as quickly as possible you stop its spread. After just two weeks of treatment, a person with TB can no longer infect someone else. TB spreads so easily, by coughing, so it could spread on a bus every day. It also spreads in households,” said Douglass.

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About Yazeed Kamaldien

Self-employed journalist and photographer from South Africa.

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