(adds government, human rights commission reaction) By Sarah McGregor JOHANNESBURG, Jan 23 (Reuters) - South Africa may forcibly isolate patients being treated for a highly drug-resistant form of tuberculosis to prevent new infections from spreading on the AIDS-hit continent, health officials said. "Holding the patient against their will is not ideal but may have to be considered in the interest of the public," Ronnie Green-Thompson, a special advisor to the Health Department, said in a statement. A new study out this week urged South Africa to consider mandatory isolation to control extreme drug resistant tuberculosis (XDR-TB), which has killed at least 74 people in the country since 2005. The study published in the journal PLoS Medicine said the government must consider all options as it fights "a major threat to public health". TB, an airborne bacillus spread through coughing or sneezing, can usually be cured through treatment. However, the XDR-TB strain may have mutated when patients skipped treatment or were dispensed inadequate antibiotic cocktails. South Africa has logged almost 400 cases of XDR-TB, which is virtually impervious to treatment by most common TB drugs, and an unprecedented 30 new cases are diagnosed every month, according to the study in PLoS Medicine. The outbreak has alarmed medical experts who say XDR-TB poses a particular danger to HIV-positive people whose immune systems are already severely compromised by the AIDS virus. South Africa has one of the planet's highest HIV/AIDS caseloads with about 5.5 million people infected in a population of 45 million. Most of those who died of XDR-TB have tested positive for HIV. South Africa's mobile workforce, rising overseas tourism, and the prevalence of XDR-TB in Johannesburg, the main transportation hub, increases the chance of XDR-TB spreading into other African countries struggling with high HIV/AIDS infection rates, the study's authors said. PERSONAL CHOICES Study co-author Jerome Singh, a lawyer at Durban's Centre for the AIDS Programme of Research in South Africa, said the public should press the government into opening the debate over forcible isolation. In South Africa, XDR-TB patients may visit hospitals as out-patients and then go home, which means they can easily pass the disease in their community, the paper said. However, the challenge to control XDR-TB requires not just policy changes but also more state spending, the paper said. Long hospital stays increase health-care costs and burden overstretched clinics particularly in rural areas with heavy patient loads, said Singh, adding hospitalised XDR-TB patients should automatically qualify for a social grant. The South African Human Rights Commission said the government could build a legal argument for overriding patients' personal rights in favour of public health, but that this should not be done lightly. "But one must be careful they don't let public paranoia become the basis for those decisions," he said, in an interview.
