The Eastern Cape is reaching crisis point with TB drug stockouts three months after reports of a global shortage of the medicines first emerged, with Motherwell Community Health Centre in Gqeberha now having just five boxes of Rifinah – a fixed-dose combination of two anti-TB drugs rifampicin and isoniazid – remaining.
A health worker at the clinic told Yoliswa Sobuwa from Health-e News they see about 20 TB patients daily and are worried their stock won’t last a month. She said they were being forced to ration the medicine and give patients just seven days’ worth of pills instead of the usual four months’ supply.
The standard treatment for pulmonary TB is six months. In the first two months, patients get a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol. In the final four months of treatment, patients take treatment of isoniazid and rifampicin – usually given in the form of rifinah.
In South Africa in 2023, 270 000 people were newly diagnosed with TB, and more than 240 000 people were receiving treatment.
The World Health Organisation (WHO) has confirmed the global shortage. “The drugs concerned are the rifamycins, in particular rifampicin, which is the most commonly used and most potent first-line anti-TB drug.”
National Health spokesperson Foster Mohale says most provinces have been affected by the stockout.
Limpopo Health spokesperson Neil Shikwambane said limited quantities are still available, while North West Health Spokesperson Lucas Mothibedi said the province has about 83% of TB medicine available.
Dangers of treatment interruption
The clinic health worker Health-e News spoke to was concerned the shortage could lead to patients defaulting on treatment.
Professor Susan Purchase, a research clinician at Stellenbosch University’s Desmond Tutu TB Centre, said interrupting treatment lowered the likelihood of a person being cured of the disease.
Research shows that a 10% rise in TB drug shortages lowered the cure rate by 2.1% – the percentage of sputum-positive TB patients who become smear-negative; and the success rate by 1.4% – the percentage of all TB patients started in treatment who were cured or who completed treatment.
“Patients who miss doses or stop treatment may once again develop symptoms of TB. Those who relapse may develop more severe forms of TB and would need to restart TB treatment,” she said, adding that treatment interruption means the bacterium may not be completely eradicated and may begin to multiply.
“Patients with actively multiplying TB germs in their lungs are infectious and can pass TB to other people.”
She said patients who miss less than two months of their treatment can have the missed doses added to the end of their treatment regimen, but those who miss more than two months would need to restart their treatment regimen.
Impact of drug shortage
The WHO said two factors have led to the shortage, one being the unreliability of the supply of the active pharmaceutical ingredients (API) prequalified by the WHO because of the sudden closure of a supplier.
The second factor is the shift in 2024 by several high-TB-burden countries from using TB medicine from non-WHO prequalified suppliers to prequalified suppliers.
This has added pressure to the global market.
However, the WHO says this has not had an impact on treatment adherence.
“The supply shortage issue is being addressed by increasing the number of WHO prequalified API suppliers and by discussing supply orders with the largest high TB burden countries to control sudden requests of WHO prequalified medicine that could affect supply availability for other countries.”
The shortage is expected to be resolved by May.
See more from MedicalBrief archives:
How the state is working to reduce stockouts
TB drug shortages hamper North West healthcare
High prevalence of ARV and TB stockouts — SA survey
Stop Stockouts introduces online report facility for whistleblowers
Urgent boost and reality check needed for HIV and tuberculosis funding