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TB research has become marked by complacency and lack of funding, as the disease faded from high-income countries.
In South Africa, for example, tuberculosis prevalence has increased threefold in the last ten years and is now the number one killer of South Africans. The country made headlines in 2006 when reports emerged of a highly lethal strain of XDR-TB in a rural village called Tugela Ferry. South Africa instituted a controversial policy of detaining drug-resistant tuberculosis patients in quarantine hospitals, like the Sizwe Hospital in Johannesburg where Fanyana is quarantined.
In 2008, I rode along with community health workers in a pilot program studying the use of community-based treatment of drug-resistant tuberculosis in the rural area surrounding Tugela Ferry. Because MDR-TB takes two years to treat, the study is only now seeing the results. Approximately fifteen people who completed their MDR-TB treatment in the community-based program are cured. There have been no cases of household transmission and, while the numbers are preliminary, mortality rates seem to be well below the 67 percent rate seen in other programs. In part because of the success of this study, South Africa has since announced plans to decentralize treatment and institute more community-based treatment programs.
Despite research and funding woes, there are a handful of new drugs in the development pipeline. “Things are more encouraging now than they have been anytime since I started doing this work in 1996,” says Mitnick. Still, these drugs will have to be deployed carefully and in combination with other drugs to avoid the same patterns of resistance that have occurred with older drugs.
Because of the need for combination therapy, the Critical Path Institute, the Gates Foundation and the Global Alliance for TB Drug Development have launched a new initiative aimed at speeding up the development of new TB drug therapies. Working with pharmaceutical companies and the FDA, the initiative seeks to lessen the regulatory hurdles for TB drug regimens, by testing out promising new drugs in combination with others in early-stage drug development and pushing forward with promising regimens.
At Sizwe Hospital, one young girl bounced in her seat as she told me that she was going home soon. She was nearing the end of her successful treatment for MDR-TB. Another little girl, whom I had seen on my last trip, had gone from an emaciated, lethargic child who was too sick to walk or attend class to a bright-eyed little girl who ran after a crowd of kids as they played in the hallways. She was still deaf, a side effect from the medicine that may always be with her.
For these two girls, 128 years of research on tuberculosis has succeeded in giving them a chance to live. The question will be whether South Africa, and other countries hit hardest by the tuberculosis epidemic, will have the money and resources to treat the millions of other TB patients who will need it going forward.
Elizabeth Chiles Shelburne reports on issues including HIV/AIDS, tuberculosis, malaria, access to water and how high food prices affect the health of populations in the developing world.