Tuberculosis: monitoring every patient

[8 October 2010 - 14h09]

Twenty thousand lay health workers have been trained in the Republic of South Africa (RSA) since 2003 to provide individual monitoring of patients treated for tuberculosis under the Tuberculosis Free programme. Launched in 2003, this massive programme is the result of a tripartite partnership between South Africa’s Ministry of Health, the Nelson Mandela Foundation and the French firm Sanofi Aventis. It is the job of these health workers to ensure that patients follow their TB treatment correctly. In total, 20,000 workers have been trained … not one too many as the task is enormous…

“According to the WHO, treatment for tuberculosis must be continued for a minimum of 6 months in order to be effective. The WHO also believes that treatment followed badly or incompletely is in fact worse than no treatment at all. This is because it encourages the emergence of resistant strains”, explains Dr Robert Sebbag, Sanofi Aventis Vice President, responsible for the Access to medication programme.

The development and multiplication of these new strains of bacilli, resistant or even ultra-resistant to the antibiotics used against tuberculosis, is indeed extremely worrying. Treatment then becomes much longer, more complex and more costly … and in some cases impossible. Yet treatment is difficult and restricting. The development of new formulas must, of course, make it possible to simplify and reduce the duration of treatment which could be cut from 6 months to 10 or 12 weeks. But the constraint of observance of treatment remains.

It is therefore vital to ensure that each patient follows their treatment correctly. And this is why the TB Free programme has been set up. “Medication alone is not enough”, Dr Sebbag firmly explains. “It is crucial to ensure that patients take their medication properly and explain to them why observance is essential to the success of their treatment plan”.

Explaining, informing, checking and reassuring … The 20,000 health workers trained under the TB Free programme – the so-called DOTS supporters, named after the WHO’s anti-TB strategy – are personally responsible for “their” patients. “Each worker has responsibility for 10 to 15 patients”, explains Dr Sebbag. “Today they are divided among 9 centres throughout the territory of South Africa” and in total around 300,000 patients are benefiting from this programme. “In 2003, the cure rate for tuberculosis in South Africa was estimated at 50%. Today we are close to 70%, though the WHO is aiming for an 85% rate of effectiveness. The target is therefore in sight.

A new programme known as TB Free 2 is now under consideration. “We would like to extend it to public health in general, and also allow other countries to benefit from this experience”. Because tuberculosis on its own represents a considerable challenge. While there are 400,000 new cases every year in South Africa, worldwide there is a new case every second. Making a total of 3.1 million cases per year …

Source : Interview with Dr Robert Sebbag, 16 September 2010; WHO; Aide-mémoire No. 104, May 2010

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