Jason Andrews (
Ramnath Subbaraman, Yale University School of Medicine, New Haven, Connecticut, United States of America
The authors have declared that no competing interests exist.
Singh and colleagues [
One irony of this discussion is that patients diagnosed with drug-resistant TB in KwaZulu-Natal are being turned away from the referral hospitals where second-line therapy takes place. There is a waiting list of more than 70 patients for admission to King George V Hospital, where the majority of MDR-TB therapy is provided. Rather than keeping patients “in”—the debate posed in this article—the reality is that health services are unable to accommodate the burden of MDR-TB patients seeking care.
The authors cite United States policies during MDR-TB outbreaks as evidence of the success of detention but fail to note that US confinement measures were rarely invoked. The New York City Tuberculosis Working Group concluded: “It is unethical, illegal, and bad public health policy to detain ‘noncompliant’ persons before making concerted efforts to address the numerous systemic deficiencies that make adherence to treatment virtually impossible” [
It is estimated that the South African government will spend 15 billion rand (~US$1.9 billion) for the upcoming World Cup, much of it for building stadiums [
While Singh and colleagues discuss the importance of “reciprocity,” they fail to mention the most important reciprocity obligation of those instituting confinement: providing the proper standard of medical care to detained patients. At present, many XDR-TB patients are provided therapy that includes only two active agents—a recipe for amplification of resistance. While XDR-TB patients elsewhere have been successfully treated with other regimens [