the South African meeting with tuberculosis (TB) experts from the World Health
Organisation (WHO), South African Reserve Bank, Pretoria
17 October 2006
Colleagues from the South, Southern Africa's Development Community (SADC)
region,
Scientists and officials from the WHO,
Laboratory scientists from the National Health Laboratory Services (NHLS)
Researchers and clinicians from the Medical Research Council (MRC) and
universities,
Experts from the Medicines Control Council (MCC) and pharmaceutical
industry,
Representatives of the mining sector and private sector,
Government officials from health, correctional services and military
services,
TB programme managers and communication officers,
Ladies and gentlemen,
Welcome,
The South African Department of Health has organised this two-day workshop
to meet with scientists and TB experts from the WHO in order for them to assist
us to consolidate and review existing national and regional strategies and
action plans that are already in place to address the management of TB
including multi-drug resistant (MDR) TB and the occurrence of extremely drug
resistant (XDR) TB.
This gathering is as a result of an urgent request by the Minister of
Health, Dr Manto Tshabalala-Msimang, to the WHO for support on how to properly
address this challenge.
Unfortunately the Minister could not be here this morning because of ill
health. However, we have among us, colleagues from the SADC because this
challenge needs a regional approach, taking into consideration the prevalence
of TB in the region and continent.
We expect to be fully briefed by this meeting on the current status of 'Stop
TB' globally, and agree on the framework for the regional strategy to prevent
and control TB, including MDR and XDR TB. We also expect this meeting to come
up with a plan of action with regards to the strengthening of identified areas
in the TB programme, and have consensus on how this will be done in the region
and in the individual countries. The other benefit of this meeting will be to
clarify the various issues around MDR and XDR TB so that countries and regions
are empowered with understanding, which will assist them in dealing with the
challenge. We also hope to benefit from the WHO report on the outcomes of the
recently held meeting of the global task force in Geneva last week, which also
came up with the new definition of XDR TB.
This workshop is also a follow-up to the Minister of Health, Dr Manto
Tshabalala-Msimang's meeting with South African TB experts, clinicians and
laboratory scientists, which we conducted in Johannesburg on 18 September 2006,
about the nature and extent of the problem of XDR TB. The experts expressed
that there was an urgent need to strengthen the country's TB control programme,
surveillance systems and infection control systems among other things.
What our local experts told us is very similar to what the WHO has proposed
as initial steps that need to be taken to respond to XDR TB in Southern Africa.
Given the prevalence of TB in Southern Africa, the Minister of Health of South
Africa also met with the SADC Ministers of Health in Mozambique Maputo on 22
September 2006, to brief them about the situation in South Africa. The
Ministers agreed that indeed the XDR TB challenge needed a regional
approach.
There has been an increase in the number of TB cases detected in South
Africa over the years with a low cure rate of 50 percent and a high defaulter
rate of 10 percent. This without doubt has resulted in a high proportion of MDR
TB cases. Unless we make special efforts to test MDR patients for resistance to
other drugs, we will be unaware of the presence of XDR TB amongst our TB
patients.
We have made diagnosis and treatment accessible to all communities and
provided these services free of charge to the communities. Support systems for
TB patients have been established for both social and psychological needs.
Despite all these efforts we are not winning the battle, so where could the
problem be? This is question we need to answer here today and tomorrow and come
up with recommendations about what we need to do to address the current
situation we find ourselves in now.
Clearly the fact that there has not been much investment into research for
new TB drugs or new diagnostic tests has also resulted in the situation we find
ourselves in. In the field of new diagnostic tools nothing much has happened
and we still rely in the main on the microscope to confirm the diagnosis of TB,
to this age. This tool has become obsolete and we need to look at better tools
which can be used at the point of care and maintain acceptable specificity and
sensitivity. This will greatly reduce the current waiting period for results
which causes delays in onset of treatment and therefore continued spread of
infection in the communities.
We must, therefore, urge pharmaceutical and diagnostic companies to correct
this gap with respect to new TB drugs and new TB diagnostic tests. We also need
to revise our strategies to ensure early detection of resistant strains and
have a surveillance system in place to monitor the resistance patterns.
Judging by the programme of this workshop which includes discussions about
strengthening TB programmes, laboratory services, surveillance systems,
infection control systems, access to rational TB treatment and communication
strategies, I am confident that by this time tomorrow you would have undertaken
a thorough discussion on TB. This would enable concrete recommendations and
time frames about what actions need to be taken by all countries to
successfully address this challenge.
With that I wish you fruitful discussions.
Issued by: Department of Health
17 October 2006
Source: Department of Health (http://www.doh.gov.za/)
