By Martin Pollack

The City of Cape Town's eight health sub-districts boast the best rate of curing tuberculosis in South Africa. And two of the sub-districts can claim a cure rate that is just a few percentage points short of the World Health Organisation's goal.

There are 25 000 people in the City's metro area who have TB; about two-thirds of these people are also living with HIV and Aids.

"The City's cure rate of 71% is the best in the country for a whole district," says Dr Ivan Toms, the Director of Health, "and we are making steady progress toward achieving the overall goal of 85% for new, infectious cases of TB."

"The Southern sub-district has achieved an 82% cure rate over the past year and the Tygerberg sub-district 81%," says Toms. The Langa sub-district, despite its particularly high number of cases (750), has attained a 92% cure rate over the last quarter.

"The City's health directorate uses the World Health Organisation's DOTS (Directly Observed Treatment Short Course) method in its 93 clinics, as this is one of the most cost-effective tools," says Toms.

TB is completely curable, but only if people complete the full course of treatment. During the intensive phase of treatment, patients take four different medicines five days a week for two to three months; during the continuation phase, they take two medicines five days a week, for four to five months.

It is not surprising that people have found these treatment regimens difficult to follow, which is why the DOTS strategy has proven to be so successful.

"DOTS is not just about people directly observing patients taking their medication at the clinics," says Toms. "For DOTS to work the focus has to be on motivation, support and encouragement."

The City works closely with the TB Care Association and other non-governmental organisations to recruit and train TB treatment supporters. These supporters visit clients at home or observe them taking their treatment in the clinics. They are paid a stipend per client and are encouraged to take responsibility for no more than 10 clients a month.

People who stop taking their medication, or take it intermittently, are likely to develop multi-drug resistance. This means that not only is their own TB more difficult to cure, but they might pass on this resistant TB to others. The DOTS strategy therefore assists people who do have TB as well as those who do not.

"City Health Services has gained valuable insight from treatment supporters involved with antiretroviral treatment for Aids," adds Toms. In Cape Town, people taking ARVs are attaining 98% adherence to treatment after six months. The team is to incorporate lessons from the ARV-support model practised by the Treatment Action Campaign.

Source: City of Cape Town - official site