TB in SA – where are we and where are we going?
PhD student from UKZN’s Department of Paediatrics, Dr Elizabeth Spooner, charted the journey of tuberculosis (TB) as a disease and later an epidemic, with a close focus on South Africa’s nationwide effort to eradicate it, during a well-attended MRC/info4africa KwaZulu-Natal Community Forum.
Using the World Health Organization’s (WHO) Global Tuberculosis Report 2013 as a primary reference point, Spooner highlighted TB prevalence and incidence rates across the globe, remarking that in terms of population size and infection rates, Swaziland and South Africa carried the highest burden of the disease in the world.
‘Whilst Tuberculosis globally infects HIV-negative individuals, it is still very much a syndemic in South Africa, whereby HIV-positive individuals are more likely to be infected by it. In South Africa, only 50% to 74% of HIV-positive TB patients are actively enrolled in a TB treatment programme – something that needs to be addressed and managed quite closely,’ said Spooner.
‘In terms of diagnostic tools, South Africa has seen great success in implementing GeneExpert. Launched in South Africa in 2012, GeneExpert is a cartridge-based, sputum-testing device which is now available in 100 sites across the country. GeneExpert not only detects Tuberculosis but can also help detect MDR and XDR-TB, making it an important tool in the fight against TB.
‘In terms of mortality rates, TB is still the number one killer in South Africa although its power is decreasing thanks to extra effort and resources being allocated to diagnosis, treatment and care of patients.’
Dissecting South Africa’s national action plan to provide adequate diagnostic and treatment services for TB patients and communities affected by TB, Spooner highlighted key elements of the National Tuberculosis Management Guidelines, as released by the Department of Health this year.
Paying particular attention to the role of health care workers, Spooner reminded the audience that health care workers were highly likely to contract TB and should, therefore, be regularly tested and encouraged to take action if they fell ill. She also underlined a key recommendation of the National Tuberculosis Management Guidelines, whereby ‘integration of care provided to co-infected patients preferably by one service provider will ensure comprehensive management of the patient, reduce morbidity and mortality and improve treatment outcomes’.
Looking to the future, Spooner gave brief insight into new treatment regimens discussed at the recent SA TB Conference, including Bedaqualine, which is being specifically formulated for MDR and XDR-TB and PA828 with the aim being to reduce TB treatment time.
‘In terms of new diagnostic systems currently under review, TB LAM is a urine test that has been proposed as a point of care TB diagnostic test, whilst TB LAMP is a smaller, yet cheaper version of the Gene Expert machine.’
Spooner said she was optimistic in the light of increasing new research, diagnostics and treatment options becoming available in the fight against TB. ‘Whilst the Millennium Development Goal Number 6, which aims to have TB falling by 2015, may not be achieved in South Africa, we could be on the path to eradicating Tuberculosis as a public health concern by 2050.’
- The MRC/info4africa KwaZulu-Natal Community Forum is convened monthly, as a partnership between the Medical Research Council and info4africa. The forums highlight important research and developments in health, wellbeing and socio-economic development in South Africa. info4africa is a self-funded Centre at UKZN’s School of Applied Human Sciences, College of Humanities. Forum attendance is free.
For more information regarding these community forums or info4africa, please visit www.info4africa.org.za