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Better Strategy Needed to Stop TB in Africa, says Doctor


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In southern Africa, TB infection rates are rising rapidly. And it may be a result of conditions similar to those that existed many years ago in the West. A South African doctor says treatment alone is not enough to slow the spread of tuberculosis.

Dr. Robin Wood is director of the Desmond Tutu HIV Center in Cape Town.

"Southern Africa is one of the fastest urbanizing populations. And these are people that are moving to the cities for work – a situation that actually is very similar to what was happening a few hundred years ago since the industrial revolution in the now developed world. That's when TB rates really went through the roof. And I think we're seeing the same phenomenon," HE SAYS

That phenomenon, he says, puts his country in a unique, but unfortunate position.

"South Africa is a relatively small country – less than 50 million people. We're the fifth largest number of TB cases in the world. And that's after countries like India, Indonesia and China, which have much larger populations. So, our TB rates are much higher than those other countries. So the burden is massive," he says.

Many of the townships around Cape Town are filled with people infected with both TB and HIV, the virus that causes AIDS.

"I come from the city of Cape Town with three million people. We have twice as much TB in that one city as you do in the whole of the United States of America. I think the rates of TB we've got are probably 60 to 100 fold higher," he says.

Easy transmission of TB

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Part of the problem he says is the close quarters in which many people live in the townships. But besides that, many dwellings have no windows to protect against both the cold and crime. The poor ventilation can create a prime environment for TB infection.

Wood says research done in the communities around Cape Town revealed very early exposure to the disease.

"Young kids coming into school at the age of five, 20 percent of them are already infected with TB. At the age of 15, before they become sexually active, 55 percent of them are infected with TB and 2 percent have had TB. By the age of 25, 80 percent of them are infected and 8 percent will have already had TB," he says.

Dual infection

But why are children exposed to so many adults with TB? Wood says it's because many adults have weakened immune systems from a co-infection.

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"What I think has happened is the HIV epidemic has just unleashed this. And it's a bit like pouring petrol onto the fire. And that's why we're seeing these very high rates.... We have to stop the transmission of TB in these communities," he says.

He says it's not enough to only give HIV-suppressing drugs, ARVs, to those who come to clinics.

"We've started using anti-retrovirals at a population level to see what happens. And one of the first things we noted was that we decreased the TB mortality in HIV positive patients down to the same as HIV negative," he says.

Many health officials now recommend getting HIV positive people on anti-retrovirals before their immune systems crash when they're more vulnerable to TB. However, giving early treatment for HIV infection means more ARVs would be needed. And that costs money.

"The affordability question – tough decisions have to be made by politicians. There are so many other potential benefits from treating people – and for the public health benefits – that there needs to be a change and funding needs to be found for this," he says.

Despite the global economic crisis, Wood says health spending needs to be increased.

Getting involved

He also says to slow the spread of TB health officials need to involve communities, trade unions and launch health education campaigns. These have been successful in the West in controlling TB.

"I think people have recognized throughout the history of TB that TB is a social disease.... But, it's been recognized for a long time that good ventilation with clean air can decrease transmission within buildings very easily. And it is not beyond the wit of us to think of strategies to do that," he says.

He says many advances have been made against HIV/AIDS over the past 30 years. But there's very little new strategy in battling TB.

Dr. Wood, who met with Obama administration officials and members of congress in Washington, is on the governing council of the International AIDS Society and is a visiting scientist at Harvard Medical School.

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