Fight against TB still has a long way to go

Clinical lead Doctor Al Story points to an x-ray showing a pair of lungs infected with TB (tuberculosis). REUTERS/Luke MacGregor

Clinical lead Doctor Al Story points to an x-ray showing a pair of lungs infected with TB (tuberculosis). REUTERS/Luke MacGregor

Published Jun 10, 2024


Durban — KwaZulu-Natal is still battling the fight against tuberculosis (TB) and is unlikely to reduce the infection rate by 50% next year – a target the Department of Health had set for itself.

Speaking at the TB Conference, hosted at the Durban International Convention Centre, this week, Jacqueline Ngozo, Acting Chief Director of the Strategic Health Programme at the KZN Department of Health, said the 8.7% decline since 2015 indicated that the target could not be met.

She said that the burden was higher in men, women and children.

“What is peculiar here is that the deaths are not only high in HIV-positive people but also in HIV-negative people. So, it is important that we really look for TB and treat it before people die,” said Ngozo.

She said that nationally, the decline in the incident rate was not significant either.

Ngozo said that as they were looking at the positivity yields from 2018 to 2023 at a national level, there had been a decline from 10.7 to 6.8 % and a decline in KZN from 8.2 to 3.5%.

South African Deputy Minister of Health Sibongiseni Dhlomo said that while the fight against the spread of TB was in motion, more work was needed.

Dhlomo said SA remained one of the 30 high TB burden countries, accounting for 87% of the global TB burden. It was also among the 10 countries facing a triple burden of TB, TB/HIV, and multi-drug-resistant TB (MDR-TB).

“In 2022, the World Health Organization (WHO) estimated that 280 000 people in South Africa developed TB, with an incidence rate of 468 per 100 000 population. Additionally, around 11 000 people contracted drug-resistant TB, underscoring the complexity of our TB epidemic. Notably, 54% of incident TB cases occur among people living with HIV, highlighting the intertwined nature of these epidemics,” said Dhlomo.

He said that despite challenges, there had been some improvements.

“South Africa’s TB programme is internationally well regarded for its steady decline in TB cases, which was achieved through the rapid uptake of evidence-based approaches like GeneXpert and shorter MDR-TB regimens. These have been important interventions in our clinical management of the TB programme,” said Dhlomo.

He said that from 2015 to 2022, South Africa achieved a 53% reduction in TB incidences. TB case notifications reached 224 621 in 2022, with 74% of cases tested using rapid diagnostics and 88% of patients knowing their HIV status.

Dhlomo added that in 2023, nearly 2.9 million GeneXpert tests were conducted in South Africa. He said that despite the progress, significant challenges remained, such as inadequate testing for people living with TB and the high loss-to-follow-up.

Dhlomo noted that another challenge was low treatment adherence and persistent high mortality among TB patients, poor uptake of TB preventive therapy among close contacts of TB patients and the challenge of inconsistency in TB care quality across different regions and healthcare facilities. He said that they were yet to adequately address the socio-economic determinant that significantly impacted TB outcome, such as poverty, unemployment, inadequate housing, and undernutrition.

Dhlomo said that addressing these challenges required a multifaceted approach that included improved diagnostic tools, better healthcare worker training, enhanced patient tracking systems, and a concerted effort to reduce stigma and financial barriers associated with TB treatment.

He said that the National TB Programme remained committed to the WHO’s End TB strategy, with a goal to end TB by 2035. He said that South Africa’s fight against TB was bolstered by significant support from donors and implementation partners.

Dhlomo said that recent progress in TB vaccine development offered hope for eradication and were prepared to implement TB vaccines when they became available.

He called on the National TB Programme to address the social determinants fuelling the TB epidemic.

Sunday Tribune