MDR and XDR-TB: Revolutionising our approach to facility design for long-term care facilities improved infrastructure and services for South Africa

Abstract

South Africa has a high and increasing burden of tuberculosis, both drug-susceptible and drug resistant strains. In 2005 at the WHO-AFRO Regional Committee meeting held in Maputo, 46 Ministers of Health unanimously declared TB an emergency in Africa. A resolution at this meeting declared that unless “urgent extraordinary actions” are in place, the situation will worsen and the 2015 Millennium Development Goals will not be met. South Africa has committed itself to addressing this national crisis. The emergence of drug resistant strains of the disease has exacerbated the situation through posing a serious risk to public health. Drug resistant strains, multi drug resistant (MDR) and extensively drug resistant (XDR) TB strains can be acquired directly: MDR and XDR-TB are not necessarily acquired through defaulting on medication prescribed for drugs-susceptible strains of the disease. Experience has shown that drug resistant strains remain infectious for longer, are more time-consuming and costly to diagnose and result in significantly higher death rates. Some drugs can have severe side effects, increasing risk of defaulting and making it less feasible to treat in community settings. In addition, drug resistant strains of TB are far more expensive to treat than drug-susceptible strains. To effectively address this public health crisis, the National Department of Health has determined that all confirmed XDR and MDR-TB patients are to be hospitalised at specialised MDR-TB units for a period of some months. However, existing longterm care facilities for the treatment of TB patients are frequently poorly designed to address needs of MDR and XDR-TB sufferers and the healthcare workers who take care of them. The aim of this paper is to outline research aimed at determination of best-practice guidance for provision of appropriate building infrastructure for MDR and XDR-TB sufferers