World TB Day 2016

International World Tuberculosis Day (WTBD) will be commemorated on 24 March under the theme of “Unite to end TB”. 

South Africa has the sixth highest TB prevalence in the world (first, when adjusted for population size), and is one of the 22 high burden countries that contribute approximately 80% of the total global burden of all TB cases. This is according to the National Health World TB day report.

The Western Cape currently has the fourth highest TB incidence rate (drug sensitive and drug resistant) in South Africa (739.1 per 100 000 population). The highest incidence rate is in the West Coast (1 112/ 100 000), followed by Central Karoo (1 012/100 000), Cape Winelands (935/100 000), Overberg (848/100 000), Eden (825/100 000) and Metro (646/100 000). However, because of the very large population in the Metro, the Metro has the largest actual number of cases of TB. 

The TB incidence rate over the past years since 2009 has decreased from over 1000/100 000.

The Western Cape Department of Health reported a Treatment success rate for all TB’s of 82% in the 2013/2014 financial year. With the quadruple burden of disease, especially the effect that HIV has on the population, it is important that all TB clients who are HIV positive access anti-retroviral treatment (ART). The Western Cape has initiated life-saving ART treatment for 96% of all HIV positive clients who are infected with TB.

Last year (2015) the Western Cape Department of Health screened 654,661 people for TB, and started 42,092 people on TB Treatment. It should be highlighted that the Province is gearing itself for showing maximum impact on the elimination of TB in the Western Cape and in South Africa.

Although the province has such a good treatment success rate, all efforts should be focussed on TB prevention due to the number of cases defaulting on TB treatment. 

The latest statistics show that 9.5% of TB clients defaulted on treatment, which is an increase of approximately 1% from the previous year.

‘While the Western Cape has been successful in rolling out treatment, screenings, prevention strategies and awareness, we cannot fight this disease alone.

"More residents in this province need to take greater ownership of their health. The rate of people who default on treatment still shows that people are not committing themselves to completing their treatment and regaining their health. Community structures and civil society must also take this message forward into society," said provincial Minister of Health, Dr Nomafrench Mbombo.

The success of any health intervention strategy is heavily reliant on community support, engagement and involvement, especially with a social disease such as Tuberculosis.

In 2015 a new strategy, known as the ’90 90 90’ strategy was adopted by many countries, including South Africa. The aim is that by 2020, 90% of all people living with HIV will know their status, 90% of those eligible for treatment with ART will be on sustained treatment, and 90% of people on ART will have suppressed viral loads. 

The strategy has also been adapted for TB, so that by 2020, 90% of vulnerable groups should have been screened for TB, 90% of people with TB should be diagnosed and started on treatment, and 90% of those treated for TB should be cured. Key populations for TB, such as informal settlements and mining communities were singled out for special attention.

Planning has already commenced on how to operationalise this strategy. For TB the ever increasing pool of infection will not get any smaller unless those who need treatment are put on treatment. Reports suggest since districts started offering TB screening to all those coming into health facilities, there is a marked increase in this area of work.

Leading up to and in commemorating World TB Day, the Department will have a few events for WTBD to improve the overall management of TB, this approach entails:

• A TB Strategic Planning workshop (held on 17 March), where senior managers engaged on ways of tackling the TB epidemic and identifying areas of focus to address the TB burden, together with other relevant government structures such as the Department of Social Development, Human Settlements, Transport and Public works, amongst others.
• From 7 to 10 March and 14 to 18 March a door-to-door drive was conducted in the Wallacedene and Bloekombos area. This formed part of an attempt to reach people living in informal settlements who are defined as key vulnerable groups for TB.
• On 24 March the Desmond and Leah Tutu Legacy Foundation will be donating 10 ECG machines to the department.
• On 24 March our staff will show support for all people with TB by embarking on a social media campaign called “unmasking the Stigma campaign”, look out for more details on this
• In April 2016 an Infection Prevention Control summit for Health Care Workers will be undertaken in collaboration with the Health Impact Assessment Directorate, TB programme and TB partners which will focus on practical steps that will lead to prevention of infections amongst staff in the services. 

According to the Western Cape Mortality Profile 2013, TB remains one of the leading causes of mortality within the province. The TB Strategic Planning Workshop, led by the Head of Health, recognizes the impact that TB has on the communities and identified addressing the TB epidemic as a priority area of focus.

The key message from this workshop was ‘do the basics right and take our communities with us’.

The primary focus is on strengthening the current systems and practices by improving the screening, treating and retaining of patients. This aligns to the UNAIDS Global and National 90 90 90 Strategies, as well as aligns to the WHO End TB Strategy.

Another focus will be on educating the public about the facts around TB and efforts to alleviate TB stigma within the community. This will be achieved through different modes of communication and social mobilization to increase the awareness in communities and promote community involvement and intervention. There will also be an aggressive drive at all levels of the health services to strengthen the case findings, prevention strategies and contact tracings.

Intersectoral and interdepartmental collaboration will be an area receiving more attention as it is recognised that social determinants of health greatly impacts the TB disease. TB is therefore not only a health issue, and needs to be addressed across all departments. Alleviating poverty and improving living conditions is most important in tackling TB. Successful TB control is ultimately a partnership.

Please also refer to attached infographic which depicts the number of TB cases since 2005 – 2014.

Together, we can stop the spread of TB: