THE Department of Health is expected to launch new tuberculosis guidelines at the South African TB Conference, which began in Durban yesterday. To be released in at least three parts, the new guidelines incorporate the latest guidance from the World Health Organisation on the use of the country’s rapid TB GeneXpert test to diagnose TB outside the lungs as well as in children. Previously, the two-hour test had only been used to test samples of sputum, or mucus coughed up from the respiratory tract, to test for TB and multidrug-resistant TB (MDR-TB). Now, samples of lung lining as well as fluid extracted from the spine and, in the case of children, the stomach can also be tested using the machine, according to the Department of Health’s director for TB control, Dr Lindiwe Mvusi. The Department of Health has also created a separate, shorter guideline on treating TB in children, although the country continues to battle with a lack of paediatric formulations, Mvusi said. She said that since SA did not have the correct formulations, the department has had to provide clearer guidance on how to dose children. She added that the latest WHO recommendations showed South Africa might have been previously underdosing children with TB. The new guidelines also include renewed pushes for tracing close contacts of TB patients who may have also developed the disease, as well as regularly offered screening at clinics. The guidelines also feature new indicators to allow the country to better track how long patients screened with GeneXpert take to start treatment and how many of them are actually started on treatment. According to a Human Sciences Research Council (HSRC) study presented in Cape Town last week, the GeneXpert had dramatically cut the time it took to get MDR-TB patients on to treatment since it was introduced in 2011. However, researchers noted that patients still wait more than the national target of five days. Also, the microwave-sized machine had yet to increase the number of TB cases diagnosed annually compared to traditional TB testing, the HSRC said. New guidelines on the prevention of TB are also expected to be released at the conference. Isoniazid preventive therapy (IPT) uses one of the drugs used to treat TB to prevent people who do not have active TB from developing it. Although the Department of Health first introduced IPT as part of its guidelines as early as 2004, the uptake of IPT has been slow. This may be in part because it was usually included as part of HIV treatment guidelines, according to Dr Gavin Churchyard, chief executive of the Aurum Institute, which helped draft the new IPT guidelines. Acknowledging the raging epidemic of TB in South Africa’s mines, the new IPT guidelines include how to use IPT with gold miners who also have silicosis. They also make South Africa the second country in the world to adopt a three-year course of the drug to prevent active TB. Currently, a lack of long-term IPT clinical trials means that bodies like the WHO do not yet have data for how safe it is to use IPT for more than three years. Aurum is hoping to provide some of this data through future clinical trials.
Laura Lopez Gonzalez: Health-e News Service, 10 June 2014