Access to TB Treatment, Prevention and Diagnostics

ENSURE ACCESS TO THE BEST AVAILABLE MEDICINES AND REGIMENS
 
South Africa continues to pay higher prices for many medicines than what is available internationally. Linezolid, for instance, is unaffordable and should be available at lower costs. Pfizer charges R8,460 per patient per month for use of linezolid in the public sector and more than double this for NGOs, such as MSF. South Africa should pursue strategies to further reduce prices. Strategies could include importing lower cost medicines from overseas or pooling procurement with other high burden countries.
 
Additionally, new medicines such as Bedaquiline and Delaminid, which have shown promising results in phase II trials like can provide a potential chance of cure for select patients that have no other treatment options. Access to Bedaquiline is already available in a number of countries under compassionate use, but remains unavailable to patients in need in South Africa. 
 
The MCC must approve use of the promising phase III drugs for compassionate use, once medicines in the pipeline receive pre-approval or approval from the Food Drug Administration, they must be fast-tracked by the Medicine Control Council for registration.
 
Statement by Mark Harringting at FDA Bedaquiline Hearing
 
DECENTRALISE DR-TB CARE
 
The Department of Health has developed a policy framework for decentralised care of TB and begun to provide decentralized care in some sites. Costing of decentralised care has shown that it will reduce the costs of the programme by reducing the number of patients who stay in specialised hospitals as well as the length of time patients stay.
 
The TAC, S27, OXFAM and MSF hosted TB activists meeting at the TB conference in Durban ICC in June 2012 before the opening of the conference. The meeting brought together TB clinicians, counsellors, patients, activists and academics. Speakers and participants drew attention to the many challenges and failures of the country’s response to TB and DR TB, but also highlighted important opportunities to begin to reduce new cases and reduce mortality. Amongst the hot issues was decentralisation of DR TB care beyond one site per province, infection control in overcrowded places like correctional services, access to current DR TB drugs like Lenazinid and access to future TB drugs in the pipeline like Bedaquiline and Delaminid.
 
Presentations from the meeting:
 
Bruce Margot and Virginia Azevendo: TB Control Programme KZN
Collen Daniels: GeneXpert Pricing and the Need for Affordable TB Diagnostics
Decentralised Management of DR-TB: A Patients Experience
Robin Wood: Durban Prisons- June 2012
Hellen Cox: DR TB Medicines
Norbet Ndjeka: How Far Have We Come in Decentralising MDR-TB Nationally
 
REDUCE CROWDING IN PRISONS AND IMPLEMENT ACTIVE CASE FINDING AND INFECTION CONTROL MEASURES- Dudley Lee V Minister of Correctional Services
 
South African prisoners are facing a crisis of TB, but there is little political will to address the epidemic. Researchers from the University of Cape Town and Stellenbosch showed a 90% probability of TB transmission per patient per year in a large South African prison.
 
The main drivers of these high transmission rates is overcrowding of prisons. Prisoners are commonly held is mass cells in extremely close proximity for up to 23 hours per day. Proper implementation of regulations regarding national cell occupancy would reduce transmission by 30%. Implementation of international cell occupancy regulations, coupled with active case finding, ventilation, and reduced time in cells would reduce transmission by 94%. The Department of Correctional Services and Department of Health must address the crises of TB in South African prisons by implementing measures, including reducing crowding, to reduce transmission. Further, prisoners that are TB positive must be diagnosed earlier and receive proper treatment to reduce mortality.
 
TAC, the Wits Justice Project and Centre for Applied Legal Studies, represented by SECTION27, are participating in this case as Amici Curiae.
 
Documents for the case:
 
Founding Affivavit by Ms Nonkosi Khumalo in Amici Application
Expert Affidavit of Professor Robin Wood
Section 27 Briefing note to the TAC
Memorandum to Polsmoor Prison and the Department of Correctional Services
Judgement in case of D Lee V Minister of Correctional Services