Prof. Dheda on a mission to find ways to fight TB

Professor Keertan Dheda, head of the University of Cape Town’s division of pulmonology, and of respiratory services at the adjoining Groote Schuur Hospital, is speaking to Spotlight from his parents’ home in a retirement complex in Durban. He is in Durban for a TB trial site visit at the Inkosi Albert Luthuli Central Hospital.

Our conversation is off to a brisk start as he recalls completing the 109 kilometre Cape Town Cycle Tour despite adverse weather conditions earlier this month. “The start and just past Cape Point, it was sheeting with rain and lots of wind,” he says. “I struggled through the first half, but then it was fine and I managed to finish safely.”

This year he completed the race in 4 hours and 42 minutes, longer than his usual 4 hours and 15 minutes.

“All things considered, I’m happy with that,” he says.

On the topic of numbers, Dheda holds an extraordinary H-index of 88. (H-index or Hirsch index measures the global impact of a scientist’s research. A ranking of 60 is considered exceptional.) In South Africa, he has an NRF [National Research Foundation] A-rating, denoting him “a leading international scholar”.

Given his fast-paced career, could “appreciating the scenery” apply as a broader metaphor?

“Yes, I feel very strongly about prioritising,” says Dheda. “And that’s how I structure my day. We have to take moments to do important things; having a morning routine, an exercise schedule. Otherwise, it becomes a robotic existence, a drudgery. And so, one must be very careful not to overload the plate with what we call mundane tasks. You know, I’m really passionate about my patient interactions and research. I really enjoy the journey of analysing data, of figuring out problems. So these are things to focus on.”

Dheda gives two examples of problem-solving research that excites him.

One was a multi-drug resistant TB treatment trial about ten years ago, where they hoped to find an alternative to painful, hearing loss causing injectables. “When we planned that trial, it was a bit of a pipe dream,” he recalls. “Bedaquiline (a new drug with less harmful side effects than injectables, taken in pill form) had just come out. The challenge was how to combine it with other drugs in a shortened regimen of only six months, compared to the conventional 18 to 20 months.”

“Today, bedaquiline is used as a first-line treatment in South Africa for multi-drug-resistant TB. Injectables are rarely used and only in exceptional cases. The data from our trial has defined a new aspirational threshold for the duration of multi-drug resistant TB treatment. It’s made a major splash and is currently being considered by the World Health Organization.”

Secondly, the ongoing development of a user-friendly, low-cost urine screening test for TB. Dheda explains that better tests are crucial, as globally two out of five cases of those newly ill with TB go undetected. In South Africa, Covid has resulted in a further 30% reduction in the detection of TB cases, with “undiagnosed or undetected persons” estimated at up to 200 000 people per year. In the latest of his many publications in leading medical journals, Dheda highlights the problem of the “missing TB” diagnoses in a World TB Day commentary published last week in The Lancet.

“One of the big problems we face is that we don’t have a sputum independent test for TB,” he says. “About 30 or 40% of people don’t have sputum [phlegm, a thick type of mucus in the lungs]. Or little kids, they can’t produce sputum. And our entire public health strategy relies on a sputum-based test. So about 12 years ago, we set out on finding a new set of biomarkers and chose urine. It’s easily available, it’s easy to collect. And we discovered a set of three selected biomarkers in the urine.

Dheda is a co-inventor on six patents, including the new urine test.

Among a long list of other initiatives, Dheda helped to pioneer Groote Schuur’s lung transplant service, now headed by specialist pulmonologist Dr Greg Calligaro and cardiothoracic surgeon Dr Tim Pennel. As far as Dheda knows, this is the only public lung transplant service in Africa.

During our interview, Dheda pauses to send Calligaro a WhatsApp message to obtain the latest lung transplant figures. Calligaro replies saying a total of 25 lung transplant surgeries to date, averaging about seven a year pre-COVID. Now with surgeries finally resuming, the team hopes to accelerate the service back to that number again soon.

A high-rise in central Durban

Dheda, one of three siblings, grew up in a one-bedroom apartment in a high-rise in central Durban, in the apartheid-era Casbah area. This area in Durban is seen as the equivalent of what was District Six in Cape Town. The area had no greenery or sports fields, so he played football in the surrounding streets. His father had a small clothing business, making ladies’ garments like dresses and coats. His mother helped his father and ran the home.

Dheda recalls how during the day one room in their home served as a lounge and a dining area. At night it became the children’s bedroom, where they slept on three folding beds kept in a cupboard in the passage. As a youngster, his wardrobe was a suitcase kept under his parents’ bed.

“I have only very good memories of my childhood,” he says.

Drawn to problem-solving early, teenaged Dheda wanted to become either an engineer – to solve the energy crisis, which earned him the nickname “Energy Crisis Dheda” – or a doctor. He opted for medical school, graduating from the University of Witwatersrand in Johannesburg in 1992. He first turned to pulmonary medicine as an intern at King Edward VIII Hospital in Durban, where “HIV rates were astronomical, and the most common opportunistic infection was TB”.

Dheda went on to specialise in respiratory medicine in the United Kingdom, graduating with a PhD from University College London in 2005. Today he is still co-appointed as a Professor in Mycobacteriology and Global Health at the London School of Hygiene and Tropical Medicine.

He decided to return to South Africa around 2007 – “to give back, to be near my family, and because of the weather”. At the time, he was headhunted by UCT’s late health sciences dean Professor Bongani Mayosi.

“Professor Mayosi contacted me out of the blue saying, ‘I hear you are looking to come back?’ And he said, ‘look, the only place for you is Cape Town. I want you to establish a lab here in the department of medicine.’ See, that was the kind of guy Bongani was, very charismatic, very avant garde. He did a lot of capacity building. He was a visionary. I mean, he thought generations ahead.”

So Dheda moved to Cape Town, where he still lives with his wife and three children in Newlands.

At the time, peers joked calling him a “brain gain” – the opposite of brain drain. “You know, we are always talking about people leaving South Africa. But there are so many people who come back here; foreigners who come here, bringing their skills,” says Dheda.

“I just love South Africa and have no regrets [about] returning. We have fantastic weather and fantastic, talented people. The gees, that is a nice word. It’s the only word I can think of to describe what we have here.

But he is also realistic about the country’s many challenges. “We have a really difficult and twisted past,” he says, “and there are a lot of hitches along the way. While we have to work through all of that, I think we’ll be okay.”

This story was first published on Spotlight.

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