Last month the Western Cape Health Department embarked on a tuberculosis awareness campaign during which they knocked on the doors of patients who had not collected their treatment.
From January to December 2019 Dr Abdurahman Community Day Clinic and Silvertown Clinic had 283 drug resistant patients were on treatment for TB but only 245 completed the treatment, with the rest defaulting.
From January to December 2020, 136 drug resistant TB patients were on treatment, but only 89 people completed their treatment, said the provincial department of health’s spokeswoman Monique Johnstone.
She said that TB patients received treatment for six- to nine months or even longer depending on the severity of their diagnosis or if they were drug resistant or multi-drug resistant.
She said that some of the reasons patients cited for defaulting on their treatment included dual diagnosis with HIV, substance abuse, and impoverished or crowded living conditions.
She said people generally struggled to get better because they didn’t have food, endured poor living conditions, had dual diagnosis which impacted their immunity, were abusing drugs which impacted medication compliance, or were experiencing side effects of the medication.
“The past de-escalation of services due to Covid-19 may also have contributed to the higher defaulter rates and higher spread of TB as people were fearful of attending a health facility to avoid contracting Covid-19,” she said.
She added that many patients had also left the province and spent lockdown where they had lived previously so they could not access their medication.
“In the Metro we do home deliveries to ensure high risk patients receive their medication and avoid the risk of contracting Covid-19, ” she said.
In the Public Interest (IPI) and Philani are two non-profit organisations contracted by the Western Cape government’s health and wellness department to conduct contact tracing of TB patients who no longer maintained their TB treatment and attended healthcare facilities for their monthly check-ups. These two organisations operate in the Klipfontein and Mitchell’s Plain area as part of the department’s Community Orientated Primary Care (COPC) initiative.
HIV/Aids and TB supervisor for IPI, Portia January, said that the team gets a list of TB patients who require a follow-up or must be encouraged to return to care from the healthcare facility.
They then conduct three visits to find the patient and if they cannot find them, the nurse at the healthcare facility will conduct the fourth visit at the address provided and eventually mark the person as someone who is not maintaining their TB treatment if the person is not found.
“We track the patient by finding them by their nicknames. Some people are on drugs, and we trace them to the drug den. We also have people who are in gangs and leave their original homes to hide, which makes it difficult to find them. We go out of our way to find the patient and because of our relationship with the community, we leave messages, and sometimes the patient does come to the clinic to be placed back on treatment,” she said.
She said that if they do find the patient, they explain why staying on treatment and attending follow-up appointments was important. It was also important for patients to know that TB is curable, she said.
The team conducts street-based and door-to-door outreach to educate people on TB and while doing so they often find people with TB symptoms and refer them for a test to the nearest healthcare facility.
Phelisa Bajisi, a staff nurse for Philani, co-ordinates 14 Community Health Workers (CHW). She said the challenge with tracing patients is that they give the wrong addresses at the clinic, or they moved and don’t update the contact information at the clinic.
“We trace 10 to 15 people daily who are not maintaining their treatment or did not come to their follow-up appointment,” she said.
“Covid-19 has created challenges for our CHWs, but we continue to adapt and care for our people as we want a healthy community. We also need the community to help us by supporting people living with TB without judgment. Together we can make our communities healthier,” she said.