Western Cape Government continues to implement the TB response plan
“The Western Cape is making good progress in implementing the TB response plan”
On Friday, I chaired the Provincial Council of AIDS and Tuberculosis (PCAT) and was briefed on the good progress made since the launch of the Western Cape Multi-Sectoral Emergency Response Plan to TB on 28 April 2021.
The committee reported back on developments in establishing a public-facing TB dashboard, like we have with COVID-19. This dashboard will become a critical feature in monitoring TB infection and ensuring that our response plan is effectively implemented. I look forward to the launch of the dashboard.
Addressing the TB epidemic in our province is a priority for our healthcare system but our response to TB has been impacted by the COVID-19 pandemic. During the pandemic, we have had to deescalate healthcare services to ensure an agile response. The response plan aims to get our TB response on track, promote transparency and digitise our response.
I commend the PCAT on the impressive work that they are doing in implementing the TB response plan. Civil society is playing a leading role in the response plan and I want to especially acknowledge TB/HIV Care who have played a pivotal role in implementing the TB response plan.
Our key indicators show us that to date:
- The percentage of all patients started on TB treatment is 92%;
- The TB treatment success rate is currently 79%;
- The rate of successfully treating patients with multidrug-resistant TB is 60%;
- The TB death rate is 3%,
- Our TB screening rate for the 5 years and older presenting with symptoms is 59%;
- Our TB screening rate for the children below 5 years presenting with symptoms is 71%; and
- The rate of TB patients lost to follow up is 18%.
The monitoring of data in this way will enable agile responses to ensure we improve on all metrics, and save as many lives as possible in the Western Cape.
The response plan is further guided by 9 key activities which are taking an evidence-based and data-driven approach to slowing TB, ensuring that we apply the same energy to fighting TB, as we did to fighting COVID-19 over the last year. These include:
- A Public-facing TB Dashboard
The Western Cape Government’s response to COVID-19 aimed to promote transparency and keep residents informed. We aim to take the same approach in the fight against TB.
As noted, we have made steady progress in creating the TB dashboard. The dashboard will be similar to the COVID-19 dashboard and will include case numbers, trends, and breakdowns of infections at a sub-district level. Initially, the dashboard will be updated monthly.
- Communications Campaign
We will further drive transparency and awareness through a comprehensive communications campaign, led by civil society.
The TB/HIV Care has collected and is in the process of printing positive and motivating stories from survivors of TB. This will include drug-resistant TB patients, drug-sensitive TB patients, and children, as narrated by their parents. By sharing their stories, patients will show that TB can be beaten. These booklets will be made available by the end of June 2021.
The campaign will be bolstered by an information booklet on TB for persons with disabilities which is being prepared by the Disability Sector.
- Self-Screening App
We will use and link the National TB Health Check self-screening application to the TB dashboard. The province will endorse the TB Health Check on WhatsApp.
- TB Preventative Therapy (TPT)
To date, there have been a total of 308 TPT initiations. This treatment includes a course of anti-tuberculosis medicines to prevent the development of TB disease. It is administered to people who are infected with TB or who have been exposed to it and are at a higher risk of developing TB disease than the general population, such as persons with HIV/AIDs.
This treatment is driven by community enrolled nursing assistants or ENAs. The ENAs identify children younger than 5 years and link them with the facilities to start TPT while conducting household contact tracing.
Supporting this programme, TB/HIV Care have employed 96 ENAs, allocated 24 ENAs per substructure. The ENAs assisted with TB contact tracing, recalling of treatment interrupters and supporting clients who are on treatment in their household.
- SMS Notification of TB Results
The Western Cape Government will implement an SMS notification system for TB test results for patients who have had an Xpert MTB/RIF Ultra test. This will be modelled on the SMS notification of COVID-19 results.
The SMS notification system will be implemented by the National Health Laboratory Services (NHLS) and the SMS will be on USSD, at no cost to the patient.
This SMS notification system will be piloted in the Metro and will initially be supported by TB/HIV Care. The Western Cape Government will take complete ownership of the programme and integrate it into the current system.
- Joint Screening and Testing for COVID-19 & TB
To ensure that we rapidly diagnose patients at highest risk, joint screening and testing for COVID-19 and TB will be conducted and implemented across the Provincial Department of Health.
We are being supported by NGO and NPO partners who are ensuring joint COVID-19/TB screening through workplace activations, high school health talks and screening sessions, and screening at taxi ranks.
During May, TB/HIV Care further conducted 5 mass community screening sessions, which included sputum collections.
- Implementation of Urine LAM Testing
One of the key ways that we can diagnose TB patients is through lateral flow urine lipoaribomannan assay, or LAM testing. This is recommended for those with advanced HIV disease or PLHIV with possible TB.
To support this, training for clinicians will be implemented with the assistance of Abbot, TB/HIV Care and Clinton Health Access Initiative (CHAI) and will assist us in ramping up testing.
- Digital X-ray Pilot
The use of digital X-Rays will bolster our TB response. This initiative has been supported by TB/HIV Care which funded 3 mobile digital X-ray units that are used to screen clients for TB. This has supported us in conducting and screening 458 patients through X-rays. Of which, 31% were positive for TB.
- Enhancing advocacy for socio-economic improvements
A person’s socioeconomic circumstances play a huge role in their susceptibility to TB. This is why the response plan is also conducting enhanced advocacy for socioeconomic improvements, including psychosocial and nutritional support interventions for those living with TB.
There are currently 878 TB patients in the Metro who are receiving nutritional food packages to support them in completing their treatment.
Counselling is being provided by community ENAs during monitoring visits. This has ensured that:
- 4 patients were referred to Home Affairs for an identity document and birth certificates;
- 8 patients were referred for social grants;
- 11 patients were referred for the Matrix program;
- 1 patient was advised to request a transfer and last report from their previous school. The Western Cape Education Department assisted in her placement at a nearby school;
- 2 patients were referred to the Department of Social Development (DSD) for foster care and on concerns of GBV; and
- 46 are receiving continuous counselling services and linked back to care.
I want to thank the Western Cape’s Department of Health and civil society stakeholders who are playing a significant role in implementing the TB response plan. This group of passionate and driven individuals has made significant strides to date and I look forward to seeing how we bring together the different components of the TB response plan to stop the spread of TB, and save lives, in the Western Cape.