20 Mar 2019

The Ministry of Health and Wellness is in the process of implementing new World Health Organisation (WHO) guidelines for treatment of multiple drug resistant TB (MDR-TB). 

The revised WHO guidelines will result with the introduction of new drugs for MDR-TB.

Dr Botshelo Kgwaadira revealed at an MDR-TB clinical seminar in Mahalapye on Tuesday that the move to introduce the new treatment plan was prompted by a study that WHO carried out on MDR-TB patients. 

Dr Kgwaadira said the current treatment took longer and had notable side effects on the patients, therefore, the new treatment plan was aimed at improving treatment outcomes. 

If everything went according to plan, he said, the intention was to start administering the new treatment for MDR-TB patients by October. 

Presenting the transitional plan towards implementing the new MDR-TB guidelines, he said the new drugs were found to be more effective, adding that the current treatment plan had a 70 per cent success rate, with about 20 per cent of patients dying while on treatment. 

On average, Dr Kgwaadira said the country registered 100 MDR cases annually. 

He further revealed that the health sector had over the years recorded a minimal number of patients who were lost along the way while receiving treatment, while some patients refused treatment and therefore defaulted along the way.  

“We do not have an isolation unit and therefore it is difficult to monitor patients who refuse treatment and default,” he said. 

Dr Kgwaadira said even though TB patients were being attended at all health facilities across the country, MDR-TB services were offered at six facilities being Mahalapye district hospital, Letsholathebe, Nyangabwe, Princess Marina, Ghanzi and Sekgoma memorial. 

He said around 6 000 cases of TB were recorded annually, adding “a study conducted in 2008, revealed that of all the TB cases recorded annually, 2.5 percent were MDR-TB cases. 

Dr Kgwaadira indicated that the health sector was currently engaged in preparing for the adoption of new WHO guidelines on MDR-TB treatment. 

He said the implementation strategy will include among others, training of personnel, establishment of an active TB monitoring programme and collection of data to inform both the national and global community. 

“The plan must be centred on the care of patients,” he said, adding that the transition towards adopting WHO MDR-TB treatment guidelines would revive DR-TB technical committee, update key personnel and partners involved in DR-TB management.

He further stated that the available data must be used to inform the new treatment plan. 

Presenting the new WHO recommendations, Senior Consultant from the KNVC Tuberculosis Foundation from the Netherlands, Dr Inge Koppelaar said the treatment plan will effect changes on the regimen composition, duration of administering the treatment and put more emphasis on treatment response monitoring.

 She said the anticipated changes were informed by the recently completed Phase III trials on the MDR regimen plan. 

She said the study documented 13 100 patients from 40 countries, who were on a long term MDR-TB treatment plan. “Over 2 600 records from patients treated under a short period for MDR-TB of nine to twelve months from 15 countries was also used to inform the study,” she said. 

The result of MDR-TB drugs on patients under the age of 18 years were also recorded by the study, she said.

She said injectable medication will no longer be used for MDR-TB patients on prolonged treatment routines, adding that “Fully oral longer regimen is the preferred treatment option for most patients.” 

Dr Koppelaar further added that treatment plan will be modified based on how a patient responds to prescribed drugs. 

“Shortening treatment duration to less than 18 months may be considered in cases of children without severe diseases,” she said. 

Therefore, she said monthly tests must be conducted on patients to timely identify treatment failure and the need to revise regimen.  

Dr Koppelaar said patients with a resistance to drugs were prone to chances of failure and relapse.

She commended the country for its treatment response monitoring plan, which she said was quite good compared to other countries. 

She also indicated that the best drugs prescribed for the treatment of MDR-TB must be available for all patients in need of such treatment as using effective regimen from the beginning will minimise failure.  ENDS