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Strike at the root of the problem to kill TB

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Shobha Shukla, Citizen News Service - CNS
WHO calls on countries to Unite To End TB
WHO calls on countries to Unite To End TB
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(CNS): Goodman Makanda, who lives in Khayelitsha - outside of Cape Town in South Africa - was diagnosed with multidrug-resistant TB (MDR-TB) in November 2013, when he was 30 years old. As if this was not enough, after 3 months of treatment, he was told in January 2014 that his MDR-TB had escalated to extremely drug-resistant TB (XDR-TB).

These two shocks, coming in such quick succession, not only devastated him mentally, but baffled him too: "I had never contracted any type of TB before. Moreover I did not show any symptoms of TB like coughing, sweating or weight loss. One day, all of a sudden, I just vomited blood. So I went to a private doctor, who directed me to a government clinic. There I was diagnosed first with MDR-TB and then XDR-TB. There were too many unanswered questions in my mind. I had been made to understand that if one did not complete the normal (drug-sensitive) TB treatment, then it could lead to MDR-TB. But in my case it was MDR-TB that attacked me directly. I had no clue as to why and how it had happened."

Dual Burden: TB and Diabetes

This was a very stressful period in Makanda's life. He was on 18 tablets a day plus one painful injection. He was also on insulin because of his diabetes, with which he has been living since 2002. The side effects of TB medication were terrible. He would feel drunk, drowsy, tired, listless, lost his appetite, and would not want to walk or talk to anyone.

Slowly, Makanda came to terms with his predicament. He said to himself: "It is me who is sick, and not the counsellor or the nurse. Once I change my attitude to a positive one, the medication is bound to work. If I am negative in my mind, treatment will also show negative results. So accept yourself for what you are and then everything will fall in place."

Recently, there has been a blessing in disguise in Makanda's life. He is one of the very few fortunate patients in Khayelitsha who, through the untiring efforts of Medicins Sans Frontià res (MSF), have been put on treatment with Delamanid - one of the only two (the other being Bedaquiline) new drugs to become available in the the past 50 years, that are effective against the deadliest strains of the disease, including MDR-TB and XDR-TB.

New TB drug: Delamanid

It is estimated that up to two-thirds of the nearly half a million people who acquire drug-resistant TB each year globally could benefit from Delamanid. The drug is particularly important for South Africa, which has one of the highest global burdens of MDR-TB, with 18,000 cases diagnosed in 2014. At least 7,000 people a year could benefit from this drug in South Africa, according to WHO guidance for using Delamanid. But, with the Japanese pharmaceutical manufacturer Otsuka putting a prohibitively high price tag of US$ 1,700 per treatment course for Delamanid, the drug is out of reach for most of those in urgent need of it.

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