Doctors have
recommended forcibly detaining people in South Africa who
refuse treatment for a drug-resistant form of tuberculosis,
an extreme measure meant to keep the infected away
from others to curb the spread of the disease,
according to a paper published Monday in an international
medical journal. Since detecting extensively drug-resistant
tuberculosis, also known as XDR-TB, in South Africa
last year, health officials have called for increased
measures to combat the strains, including better
surveillance, diagnostics, and drugs.
In their paper in
the PLoS [Public Library of Science]
Medicine journal, physicians Jerome Amir Singh, Ross
Upshur, and Nesri Padayatchi propose that XDR-TB
patients who refuse treatment be involuntarily
detained in hospitals or other health care facilities.
Singh and Padayatchi are at the Centre for AIDS Programme of
Research in South Africa, and Upshur is the director
of the Joint Centre for Bioethics at the University of
Toronto.
Ronnie
Green-Thompson, an adviser to the South African Department
of Health, said the idea had been discussed by health
experts in South Africa and elsewhere and was a
possibility. ''Holding the patient against their will
is not ideal but may have to be considered in the interest
of the public,'' Green-Thompson said in a statement
issued by the South African Department of Health.
''Legal opinion and comment as well as...the opinion
of human rights groups is important."
In the 1990s, New
York City health authorities authorized the forcible
detention of people who rejected TB treatment, some for as
long as two years, ultimately leading to a significant
dip in cases. The detainees were held in Bellevue or
Goldwater hospitals.
Last September,
the World Health Organization announced there were 53
confirmed XDR-TB cases in South Africa, of which 52 were
fatal. Most of the patients were also HIV-positive. To
date, more than 300 cases have been identified, and at
least 30 more are added each month.
In their paper
the doctors recommend that XDR-TB patients be paid while
being detained. ''This isn't a carte blanche to public
health authorities to start locking people up,''
Upshur said. ''If we ask individuals to forgo their
rights, they need to be supported.''
Some public
health experts say South Africa and the international
community haven't taken basic outbreak response steps, such
as drafting an emergency plan, conducting a proper
investigation, and reinforcing surveillance. WHO and
its partners have held a flurry of international
meetings since XDR-TB in South Africa was identified, but
little has changed for patients there.
''The government
hasn't yet done the most obvious things to shut down
transmission,'' said Mark Harrington, executive director of
the Treatment Action Group, a health advocacy group.
''Starting to imprison patients is a step very far
downstream from where we are now.''
Green-Thompson,
the South African Department of Health adviser, said all
measures were being considered and that early diagnosis and
treatment were ''of paramount importance.'' Others
worry that involuntarily detaining people would result
in ''driving patients underground,'' said Dr. Tido von
Schoen-Angerer of Medecins Sans Frontieres, the
international medical aid group.
Though
extensively drug-resistant tuberculosis exists worldwide,
including in eastern Europe, Russia, and the United States,
Africa's high number of HIV and AIDS patients makes it
particularly worrying. Not only does HIV fuel the
spread of tuberculosis, but infection with both HIV and
XDR-TB means almost certain death. (AP)