World TB Day: MSF's community-based project in South Africa informs new global guidance

NEW YORK/KHAYELITSHA, MARCH 24, 2022—The World Health Organization (WHO) issued new recommendations this week that children with tuberculosis (TB) and drug-resistant forms of TB (DR-TB) should be cared for in their communities rather than at centralized health facilities. This welcome guidance is partly informed by a program developed by the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) and partners in Khayelitsha, South Africa.

The MSF program in Khayelitsha began focusing on the diagnosis, prevention, and treatment of DR-TB in children in 2020. To date, MSF has reached almost 300 individuals through family-focused, homed-based activities and doubled the number of children diagnosed with the DR-TB.

While there have been many benefits to the community as a whole because of the decentralized program, it appears the biggest benefit was for vulnerable children who are usually least served when it comes to TB treatment.

“South Africa has been a global leader in the decentralization of DR-TB care, but the care of children at the community level has drastically lagged behind, with many children still being cared for by central hospitals,” said Dr. Anja Reuter, MSF Khayelitsha’s medical activities manager. “This means that kids are kept away from their support systems for long periods of time, which is really disruptive and can be psychologically damaging.”

The new WHO guidance comes after it conducted a review to assess the impact of decentralized, integrated approaches to TB care. Evidence shows that community-based and decentralized care increased the numbers of children and adolescents diagnosed with TB and initiating treatment.

Traditional TB treatment takes at least several months and often requires daily visits to health facilities—often located far from people's homes. In the Khayelitsha program, the care of children with DR-TB was done largely by physicians and nurses working in clinics based in the community, meaning children and their families could get on with their usual daily activities while at the same time receiving quality medical care without having to leave their homes.

“Almost all of the children in our program have been able to be fully treated in the community,” Dr. Reuter said. “They’ve been treated with child-friendly formulations of medications, which has been a huge relief to parents and caregivers who previously had to give the children adult-sized tablets that were painful to swallow and had to be cut up so that the dosage was right.”