Since 2007, MSF has worked with partners in Khayelitsha to address the growing epidemic of drug-resistant tuberculosis (DR-TB). MSF has implemented a decentralized model of DR-TB care, where the majority of DR-TB patients are initiated on treatment at primary health care level, a practice that avoids more expensive hospital stays and greatly reduces the time to starting DR-TB treatment.
 

Traditional healers in Khayelitsha encourage DR-TB patients to remain adherent to their two-year long treatment regimens, and are trained by MSF on when to refer cases to facilities when complications arise. Photo: Yazeed Kamaldien

 
Read the Press Release: 2016: Time for more decentralized DR-TB care and wider access to new DR-TB medicines in South Africa


Xoliswa Harmans is an XDR-TB survivor and now a counselor with MSF. Counselors provide sessions to DR-TB patients on treatment literacy and adherence planning, and involve family members to help provide adequate support through patients’ two-year long journey of taking DR-TB treatment. Counselors help move DR-TB case management outside of overcrowded central facilities. Photo: Yazeed Kamaldien
 

DR-TB patient, Goodman Macanda, with his MSF counselor and DR-TB survivor, Busi Beko. Goodman is one of the patients in South Africa who takes new DR-TB drugs as part of his regimen. “All I need to hear is that I must take my medication,” says Goodman. “I need hope that at the end of the tunnel is a light.” Photo: Yazeed Kamaldien
 

MSF has implemented a decentralized model of care for DR-TB management, as recommended by the South African Department of Health’s 2011 guidelines, but in many other parts of the country, progress to decentralize is slow, and initiating patients on treatment at primary health care facilities is not standard practice. “Some DR-TB patients are waiting more than seven months for admission and treatment initiation in centralized facilities,” says MSF Dr. Jennifer Furin. “This is an unacceptable scenario for patients, their families and communities.” Photo: Yazeed Kamaldien
 

MSF provides strengthened treatment regimens to complicated DR-TB cases to give patients accelerated access to new DR-TB drugs, such as bedaquiline, linezolid, and delamanid. Strengthened regimens offer a better likelihood of treatment success. South Africa’s Department of Health has announced targets of placing 3,000 DR-TB patients a year on regimens containing bedaquiline and linezolid. Photo: Yazeed Kamaldien
 
 
A nurse at Ubuntu clinic in Khayelitsha presents standard daily treatment for DR-TB. Patients must take thousands of pills over the two years of treatment, and suffer through painful daily injections for the first six months. MSF in Khayelitsha has decentralized treatment initiation for DR-TB patients to primary care level. By contrast, implementation of South African national guidelines to decentralize DR-TB care to primary care has been slow, meaning national targets for initiating and maintaining patients on promising new treatments are unlikely to be met. Photo: Yazeed Kamaldien
 

MSF counselors provide sessions to DR-TB patients on treatment literacy and adherence planning. They also provide structured interventions to ensure vulnerable patients interrupting treatment are guided back into care. Counselors help move DR-TB case management outside of overcrowded central facilities. Photo: Yazeed Kamaldien
 

Proper infection control measures help prevent the spread of DR-TB, and are a critical component of decentralized DR-TB management. Photo: Julia Hill
 

Community health workers in Khayelitsha meet with the Global TB Community Advisory Board. Community health workers ensure DR-TB patients receive and take their medication at home, which helps patients avoid daily visits to health facilities during two years of treatment. Photo: Yazeed Kamaldien
 

Dr. Jennifer Furin, DR-TB Clinical Manager for MSF in Khayelitsha, explains the MSF model of decentralized DR-TB care to the Global TB Community Advisory Board: “MSF experience has shown there are a number of clear benefits to DR-TB treatment initiation at primary health care level. More patients who are diagnosed start on treatment, and patients start treatment sooner, which can result in better individual outcomes and limit the time during which patients transmit the disease to others.” Photo: Yazeed Kamaldien