1. Why are new drugs and cheaper, more user friendly regimes needed?

2. "Tuberculosis, whether caused by drug-susceptible or drug-resistant strains, rarely made even medical headlines, in part because its importance as a cause of death continued to decline in areas in which headlines are written.”
Keshavjee and Farmer, NEJM, 2012*
And what TB crisis?
* Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med Sep 6;367(10):931-6.

3. Cost-ineffective?
“…selective primary health care and ‘cost-effectiveness’ have shaped an anemic response to the ongoing global pandemic.”*
*Tuberculosis, Drug Resistance, and the History of Modern Medicine. Salmaan Keshavjee and Paul Farmer. N Engl J Med Sep 6;367(10):931-6.

4. Slide courtesy: Prof Keertan Dheda

5. SA : MDR-TB already >55% of TB budget!
Financing the scale-up of MDR-TB prevention and Treatment. Katherine Floyd, Stop TB, WHO. Ministerial meeting. Beijing, China, 2009

6. The perception among the majority is that we are not at risk of being infected by TB. This assumption is deeply flawed. Dr Madhukar Pai, India Tribune, 29 October 2012
The RNTCP needs to think beyond treatment of drug-resistant TB, and focus on preventing a major epidemic. In the case of drug-resistant TB, an ounce of prevention is definitely better than a pound of cure

7. Care for the carer
±1/100: number of South Africans diagnosed with TB last year (WHO, 2012).
3x: increased rate of TB among Health Care Workers globally (Baussano, 2011).
6.3%: confirmed drug-resistance among occupational TB cases at Tygerberg Hospital (Data: ).
5.56x higher incidence rate of MDR- and XDR (O’Donnell, 2010)
Means 3/100 HCW’s could be diagnosed with TB every year
At least 1/16 could have MDR-TB or worse

8. Lucky and thankful…
Dalene got her life back, she can still hear, and can even practice as a clinician again…what next?
TB PROOF

10. Start at the beginning:

11. 2nd Year Medical Students

12. Anyone can get TB Nobel peace prize TB survivors
“UBUNTU” – I am because we are We are all in this together!

13. SA record: 114m in one breath!
HOPE: Life after TB
SA record: 114m in one breath!

14. Thank you! Physicians: Paul Willcox CBTBR/Genetics: Gerhard Walzl
Andreas Diacon
Simon Schaaf
Tony Biebuyck
Jantjie Taljaard
Keertan Dheda
Pharmacology
Gary Maartens
Elsimé Kift
Jeannine Du Bois
Supportive
Justus Apffelstaedt - Surgery
Mou Manie - Rheumatology
Anton Doubell - Cardiology
Mark Abelson – Cardiology
Prof Loock – Ear, nose and throat
Radiology
Sucari Vlok
Arthur Maydall
Jan Lotz
Occupational Health/TBH
Jack Meintjies
Sr Samuels
Sr Arendse
Matodzi Mukosi - super
Elmarie Malek
Mariana Kruger
SAMA - Daniel Madiba
CBTBR/Genetics:
Gerhard Walzl
Belinda Kriel
Daleen Kriel
Rob Warren
Tommie Victor
Soraya Bardien-Kruger
Lizma Streicher
Tibotec/Janssen:
David McNeeley
Gilles van Baar
NHLS
Mariza Hoffman
Haematology and Microbiology Technologists
Audiology:
Rene Visagie
Sharon Pithey
Tygerberg Audiologists
CAPRISA
Nesri Padayatchi
Kogieleum Naidoo
TB PROOF
Angela Dramowski
Bart Willems
Heena Narotam
Helene-Mari van der Westhuizen
Koot Kotze
Treatment Action Group
Thank you!

15. “The momentum to break this disease is in real danger
“The momentum to break this disease is in real danger. We are now at a crossroads between TB elimination within our lifetime, and millions more TB deaths.”  Dr Mario Raviglione; Director of the WHO Stop TB Department; 17 October 2012
Questions?