(Published - 24 March 2020)
The month of March is tuberculosis (TB) awareness month, and March 24 is World TB Day. While we acknowledge that South Africa and the world is currently grappling with the Coronavirus disease 2019 (COVID-19), we must continue to sustain efforts to combat TB. In fact, we would argue that now more than ever, addressing both TB and COVID-19 is crucial to stopping both pandemics and protecting TB patients who are more vulnerable to COVID-19. There are certainly many lessons from TB that should be shared in addressing COVID-19.
In South Africa, TB is one of the leading causes of death, with more than 300 000 people contracting the disease each year, and there are on average 180 deaths per day. The World Health Organization (WHO) estimates that a quarter of the world's population is infected with the bacterium Mycobacterium tuberculosis (M.tuberculosis), the major causative organism of TB, but not all these people will become sick with the TB disease. Globally, more than US$ 10.1 billion was required for the diagnosis, treatment and care of patients living with TB in 2019, while more than US$ 2 billion is needed annually for TB research.
There are several exciting and impactful research and development activities ongoing at the University of the Western Cape (UWC) aimed at tackling the various issues related to TB. These are being undertaken by, among others, the Department of Chemistry, Biotechnology, the South African National Bioinformatics (SANBI) Institute, the Schools of Pharmacy, Public Health and Nursing, and the Faculty of Dentistry. At the Department of Chemistry, cutting edge nanotechnology is being used to develop highly sensitive and rapid test kits for the detection of M.tuberculosis and for the measuring of TB drug concentrations in body fluids. At the School of Pharmacy and SANBI, researchers are working to discover new, effective and safer drugs for killing M. tuberculosis, including drug-resistant strains. Some of the potential new drugs come from the bottom of the sea, and some from South African traditional herbal medicines.
Furthermore, cutting edge bioinformatics tools, artificial intelligence and machine learning are being used to discover new drugs more smartly and to predict their safety and effectiveness. In the School of Pharmacy, researchers are also utilising nanotechnology to make nanoparticles (particles about 100 000 times smaller than the diameter of human hair) packed with TB drugs to target the treatment to sites of infection and to develop new treatments which work through the patient's immune system. Studies are also ongoing to further understand the time course of such drugs in the bloodstream and tissues of patients. These activities are aimed at providing treatments for patients that are more effective against all strains of the bacteria, that are safer and are of shorter duration. There is also work within the School of Pharmacy to improve understanding about how patients can adhere to their treatment, and potentially reduce adverse long-term effects of the medicines. Various clinical programmes focus on improved care for patients with TB, either within the primary healthcare sector or hospital sector. Research has been undertaken on the potential role of the pharmacist in screening and detecting potential patients with TB as part of a care package provided by pharmacists.
All this research is being conducted by undergraduate and postgraduate students as part of their training.
As we recognise World TB day in the midst of the COVID-19 pandemic, we should remain supportive of patients undergoing TB treatment and be cognisant of the future hope for better treatment and management of this disease offered by ongoing research and development activities. As a university community, we aim to accelerate the End TB Response – or the end of the pandemic - to reach the targets set in the Sustainable Development Goals, the WHO End TB strategy, the Moscow Declaration to End TB and the political declaration of the United Nations High-Level Meeting on TB.
Frequently Asked Questions about TB
What is TB and how is it spread? TB is an infectious disease that is caused by the bacteria Mycobacterium tuberculosis. The bacteria is spread through the air from one person to another. If a person with TB disease of the lungs coughs or speaks, people nearby may breathe in the bacteria and become infected. Unlike viral diseases like the Coronavirus, TB does not spread by shaking of hands, touching door handles, sharing food or even kissing, as the bacteria has to be airborne and breathed into the lungs to cause TB infection. People with TB disease are most likely to spread it to people they spend time with every day (e.g. family members, friends, co-workers, schoolmates).
What are the symptoms of TB disease? The most common type of TB disease is an infection in the lungs, although it can spread to many different parts of the body, e.g. the stomach, knees, kidneys or brain. Tuberculosis infection outside the lungs is referred to as extrapulmonary TB. A patient with TB disease of the lungs will likely cough regularly for longer than three weeks (sometimes with blood in the sputum), may experience fever and night sweats, and may lose weight without trying.
How is TB diagnosed? To test for TB, a health care worker will take a sample of sputum and use GeneXpert to detect the presence of the bacteria and which medicines the bacteria is sensitive to. Culturing of bacteria or observation under a microscope may also be performed to confirm infection.
Can TB be cured? Various medicines can be used to treat TB. A person who has developed TB will be given a combination of four medicines which have to be taken regularly for six months. If there are no complicating factors like HIV or drug resistant TB, most patients become sputum negative (show no bacteria in sputum and will now not transmit TB) after two months of treatment, and will be cured of TB after six months. Taking TB treatment is unfortunately not easy as the medicines have many (sometimes permanent) side effects. Last year, South Africa made international headlines after negotiating a drastic cut in the price of a relatively new once-weekly, three-month course to prevent TB. As a country, we are a few months ahead of an anticipated national rollout of the drug combination, also known as 3HP. This will protect high-risk patients, e.g. people living with HIV, children and cancer patients, from contracting TB.
Prevention of TB? All children receive the Bacille Calmette-Guerin (BCG) vaccine at birth in South Africa. This is a live vaccine given to stimulate the baby's immune system to build antibodies to protect against TB. However, this vaccine is unreliable in protecting against TB infection in the lungs. People with TB disease are advised to cover their mouth or nose when they cough or sneeze, and when living with a person with TB, one should maintain fresh airflow in rooms by opening windows.
What is drug-resistant (MDR) TB? Drug resistance happens when bacteria change in ways that stop the medicines used to treat it from working. A person who gets infected by a drug resistant strain of mycobacteria develops MDR-TB. Patients with MDR-TB are treated with a different combination of medicines, commonly referred to as second-line drugs. Most often, one of the combinations of drugs is an injectable agent. Patients have to find ways to receive the injection daily for at least two years. In 2018, South Africa became the first country in the world to make MDR-TB treatment more tolerable, and reduce the devastating impact of side effects caused by injectable agents, by introducing bedaquiline as an oral treatment. Experience with the drug bedaquiline in treating MDR-TB, mainly from South Africa, demonstrated improved health outcomes for patients with MDR-TB. Many researchers are working hard on finding new drugs that work better, have less side effects and that can kill drug resistant TB.
References available on request.