Tuberculosis management: what’s new?
Morbidity and mortality due to tuberculosis (TB) remain serious challenges in South Africa (SA) and globally. Despite the spirited fight against the disease, TB mortality, especially among people living with HIV (PLHIV), remains unacceptably high. However, recent developments in TB diagnosis and treatment provide ammunition for TB epidemic control. The novel use of molecular diagnostic tests enables rapid TB bacteriological confirmation, and hence the opportunity to initiate treatment on the same day as sample collection. In addition, molecular diagnostic tests provide Mycobacterium tuberculosis (MTB) resistance/sensitivity to rifampicin, which is a proxy to multi-drug resistant TB (MDR-TB). Appropriate treatment for drug-resistant TB (DR-TB) may therefore be initiated while awaiting further drug sensitivity tests. The availability of effective anti-TB drugs through the decentralised, deinstitutionalised TB programme is yet another opportunity to control the epidemic. Introduction of the standardised, effective, bedaquiline-based injectable-free DRTB treatment regimen has resulted in remarkably improved DR-TB management with high treatment success rates. There is also an opportunity to explore TB preventive treatment (TPT), which remains a key TB control measure for PLHIV and younger children. These key changes in TB management are a strong incentive for clinicians to better manage TB patients and control the epidemic.