South Africa will expand its rollout of GeneXpert tuberculosis (TB) testing machines, which can diagnose TB and drug-resistant TB within 90 minutes, but concerns remain about the capacity to back up this commitment with supplies and treatment.
The country is the largest buyer of GeneXpert technology in the world, but the machines have not yet become point-of-care tests and are often deployed at district rather than clinic level. Nonetheless, they have shaved weeks off waiting times for patients because samples no longer have to be transported to and from national referral hospitals kilometres away for diagnosis.
At the opening of the TB Vaccines Third Global Forum in Cape Town on 25 March, Precious Matsoso, director general of the South African Department of Health, announced that an additional 135 machines will be imported by the end of 2013. The GeneXpert was released in 2010 and South Africa already has 150.
Matsoso's announcement was made a day after the health department handed over six machines to the Department of Correctional Services at Cape Town's Pollsmoor Prison. A former inmate at Pollsmoor, Dudley Lee, took the correctional services department to court after he contracted TB during incarceration. Although Lee eventually died of TB, the courts found in his favour.
During the handover, South African Deputy President Kgalema Motlanthe also announced that TB screening for inmates would carried out every six months, and reiterated a commitment that at-risk miners would be annually screened for TB. Of the 735 Pollsmoor inmates screened for TB during Motlanthe's visit, 12 percent had TB, according to Matsoso.
The World Health Organization (WHO) lists South Africa in the top 22 countries with a high TB burden. An estimated 500,000 cases of active TB are diagnosed annually and the disease remains the leading cause of natural death according to the national statistical service, StatSa.
South Africa could become WHO observatory
Matsoso also announced that the health department, the National Department of Science and Technology, and the US-based non-profit TB vaccine developer, Aeras, would continue to fund the recently created South Africa Consortium on TB Vaccines.
"We are at the centre of the TB epidemic, so we have to have our own response… in terms of vaccines being developed. Hopefully, South Africa will become a global player," Willem Hanekom, director of the South Africa TB Vaccine Initiative, told IRIN.
Matsoso, who has worked with WHO on issues of intellectual property, said that through the consortium South Africa would be well-placed to become one of the research observatories envisioned in WHO resolutions aimed at promoting research and development. She noted that these initiatives would have to be accompanied by changes to regulations, for instance to facilitate fast-track review to allow the country earlier access potential new vaccines.
Stand and deliver
South African AIDS lobby the Treatment Action Campaign (TAC) and international medical humanitarian organization Médecins Sans Frontières (MSF) have questioned the government's ability to deliver on these promises as stockouts and slow decentralization persist.
In a joint letter delivered to South African Minister of Health Dr Aaron Motsoaledi on 22 March, the organizations stressed that the success of the GeneXpert rollout hinged on a steady supply of testing cartridges for the machines, the decentralization of drug-resistant TB (DR-TB) care and treatment, and improved supply-chain management to avoid recurring drug stockouts.
The organizations also questioned the continued delay in implementing the health department’s 2011 policy decision to move DR-TB care out of designated TB hospitals with a shortage of beds to primary healthcare clinics closer to patients' homes.
"Provincial operational plans for decentralization of multidrug-resistant TB (MDR-TB) care have not been drafted, nor have readiness assessments been conducted of all proposed decentralized MDR-TB (sites)," the letter pointed out.
The organizations urged the health department to implement the 2011 policy, which would allow all of South Africa’s nine provinces to begin initiating and managing stable adult and paediatric MDR-TB at local clinics before the end of 2013.