Cape Town - Tuberculosis (TB) services, largely disrupted by the Covid-19 pandemic, are seeing testing levels return to pre-pandemic levels.
This was according to the provincial Department of Health and Wellness, which briefed the Western Cape Parliament’s ad hoc committee on TB on Wednesday.
Service priorities co-ordination deputy director Dr Nousheena Firfirey said every time the province saw a Covid-19 wave, TB testing saw a decrease, but this has, over time, started to stabilise.
“So though there’s a relative increase in the rate of the total GeneXpert tests done, it has slowed down in 2023 compared to last year. But it is still above the median monthly rate (19301 tests) prior to Covid-19 in 2019.”
Firfirey said the median 28-day moving average for TB-specific admissions among adults has increased yearly, from 2019 to 2021.
Deaths from TB among adults increased from 581 in 2019 to 672 in 2020 and 742 in 2021.
“What this is telling us is that patients are presenting to our services much later, when the disease has progressed, and that is why the number of deaths during admission has also increased. So it shows that we need to start finding our cases earlier so we can start with early intervention, so that they’re not as sick when they present at our facilities.”
The Bacille Calmette-Guérin (BCG) vaccine for TB is provided to all infants at birth. Coverage ranged from 65%-100% across districts in 2021/22 with the lowest coverage on the West Coast.
Coverage decreased slightly in some districts between 2021/22 and 2022/23. A lower number of births could be a reason for the decrease in coverage, she said.
The province’s TB Response Plan focuses on prevention, adherence counselling and support, case detection, and linkage to care.
Brewelskloof Hospital medical manager Dr Danie Theron said George recorded the most cases of TB in the rural district, followed by Drakenstein, Breede Valley, Langeberg and Witzenberg, Cape Winelands District.
The rural district has close to 24000 reported TB cases.
Metro Health Services medical officer Dr Nosi Kalawe said 29100 cases of TB were reported in the metro, mostly in the Tygerberg area.
Challenges for the metro district include patients not returning to the facility for treatments, and staff being threatened during recalls. Infrastructure remains a challenge due to a lack of space, booths and long queues. Client home addresses are sometimes wrong and cell numbers change.
Some areas are also not accessible to high levels of gang-related activities. Drug abuse and lack of fixed residences affect the adherence and TB treatment outcomes. Long waiting lists for social workers also affect TB treatment outcomes, and a shortage of TB staff.
Kalawe said an intersectoral approach involving police, environmental health specialists, auxiliary social workers and psychologists was needed to address the challenges.