Tuberculosis (TB) has been a major public health challenge since time immemorial. A German Physician known as Dr Robert Koch announced on March 24th, 1882, that tuberculosis is caused by Mycobacterium Tuberculosis. That is why every year in March we reflect on our response to this killer disease.
This year the theme is: Yes, You and I Can END TB! And it serves as a clarion call for individuals, families and communities to play a role in the fight against TB.
South Africa is one of the 30 high TB burden countries that account for 87% of the global burden. In 2022, an estimated 11 000 people contracted drug-resistant TB, including multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB) among the 280 000 people who contracted TB the same year with an incidence of 468 people per 100 000 population.
Half of our TB patients are also living with HIV. This means that any strategy that does not address both the TB and HIV epidemics will not succeed. South Africa’s large antiretroviral programme has significantly contributed to better TB outcomes, including successful treatment and reduced mortality.
The End TB Strategy, launched by the World Health Organisation (WHO) in 2014, outlines a comprehensive and ambitious roadmap to combat TB worldwide.
The strategy that has been implemented from 2015 included milestones (for 2020 and 2025) and targets (for 2030 and 2035) for large reductions in the TB incidence rate (new cases per 100 000 population per year), the absolute number of deaths caused by TB, and costs faced by TB patients and their households.
The strategy adopts a patient-centred approach, aiming for universal access to quality TB care and promoting integrated, people-centred health services. Compared to 2015, South Africa has made spectacular improvement in the form of reduction of TB incidence.
We have witnessed a 53% reduction between 2015 and 2022. However, during the same period, we have had only a 17% reduction in deaths while 56% of our people suffer TB catastrophic costs. TB treatment coverage has increased to 77% for the first time by the end of 2022. There have been massive efforts during the last two years to find missing TB patients in order to END TB.
Our approach is “find TB to cure TB”. During the year 2023, an unprecedented close to 2,9 million GeneXpert tests were conducted in the country. We note that despite this feat, there is a need to strengthen linkage to care through SMS notifications to all individuals who test positive for TB in the country.
At the global level, the United Nations High-Level Meeting on TB, which was convened in 2018, marked a historic gathering of world leaders committed to accelerating efforts against TB. A second UN high-level meeting on TB was held on 22 September 2023. Resulting from these high-level international gatherings, there was a political declaration which reaffirmed existing commitments and targets and included new ones for the period 2023–2027.
The South African National TB Programme remains committed to the goals of the World Health Organisation (WHO) to End TB by 2035. In order to do this, we have approved a National Strategic Plan for HIV, TB and STIs (2023-2028), that sets out bold commitments to address the huge TB burden and guides our efforts to leave no one behind.
Each year, we develop a TB Recovery Plan, that guides the interventions around five core pillars, (1) Create demand for TB testing and treatment services through advocacy and communication; (2) Find the missing TB patients and Link them to Care within one week; (3) Ensure people have access to high-quality treatment and support so that we treat and retain them in care; (4) ensure TB prevention is valued as much as treatment and prepare for new prevention efforts like TB vaccines; and (5) Monitor and Assess the TB programme indicators to ensure that provinces use high-quality data to guide their TB programme implementation.
South Africa has been and remains the World Leader in the introduction of new tools to test and treat TB. The introduction of the new WHO-approved Rapid Diagnostic tests for TB has been done as early as 2010.
The introduction of new and repurposed TB drugs has helped significantly improve the proportion of cured DR-TB patients. We have rolled out shorter regimens or treatment with better drugs for Drug-Resistant Tuberculosis, otherwise known as DR-TB, with the notable launch of the BPAL-L programme in September 2023, which has almost 2 000 patients on a six-month DR-TB regimen.
Recent progress in TB vaccine development offers a glimmer of hope in our journey toward TB eradication, and we stand prepared to implement TB vaccines when they become available. In line with the theme, we remain committed that working together, we can end TB. Ending TB is one of the easiest targets to achieve, because all it requires is for those who test positive to TB must start treatment because it is curable, stay the course till the end, eat healthy food, and live healthy lifestyle, then we can indeed end TB, for together all of us can end TB. Let’s support TB patients and encourage them to adhere to life-saving treatment.
Dr Joe Phaahla is the Minister of Health in South Africa
