The protracted TB struggle - SA ups the intensity.

An ambitious programme to integrate TB and HIV services into single primary health care facilities and a R32 million European Union (EU)-funded treatment defaulter tracing project are among the chief mitigation weapons aimed at the TB pandemic this year. This emerged from an interview last month with the national director of the TB Control and Management Unit at the national health department, Dr Lindiwe Mvusi. With the HIV pandemic having multiplied South Africa's TB prevalence threefold over the past decade (Fig. 1) and the country now among the 10 worst performing in TB control internationally, Mvusi says more efficient awareness, prevention and monitoring campaigns are 'crucial'. 'We need to work harder at getting to the patient out there. Currently we pick them up passively by waiting until they come into a facility, which can so often be tragically late, let alone ineffective.' Last June Government took over the funding of a R32 million treatment defaulter (and contact) tracing and treatment support programme from the EU. It was determined to strengthen community care – even mooting the possibility of treating multidrug-resistant (MDR) patients in the community. Some 72 teams (each with a retired enrolled nurse, 2 community health nurses and a data capturer) working in as many health sub-districts, covering 726 health facilities, are doing defaulter tracing based on facility lists of patients who miss treatment, 'even for a day or two'. 'We find out what their issues are, counsel them and get them back for treatment – re-treatment patients who have to get daily injections of streptomycin are given these at home instead of travelling to the clinic at own cost,' she added. This project resulted in a decrease in the defaulter rate wherever it was implemented. Explained Mvusi: 'There's even talk of managing MDR patients in the community and we're thinking it could be added onto this current programme, but we don't want to overwhelm our teams – we'd rather increase our case findings, and decrease our defaulters and loss to follow-up first'. The other intervention with the potential for making a major difference this year when it will be significantly expanded is the Palsa-Plus (University of Cape Town Lung Institute-designed) programme aimed at early diagnosis of lung diseases, including TB, and effectively managing TB/HIV co-infected patients. (Palsa = Practical Approach to Lung Health in South Africa). It was piloted in the Free State in 2004, where clinics reported …