Tuberculosis control has failed in South Africa--time to reappraise strategy (original) (raw)
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Tuberculosis control in South Africa: Successes, challenges and recommendations
South African Medical Journal, 2014
Tuberculosis (TB) remains a global health threat. Despite a slow decline in global TB rates, the World Health Organization (WHO) reported 8.6 million new cases of TB in 2012 (13% in people living with HIV), resulting in 1.3 million deaths (23% among HIV-positive persons). [1] South Africa (SA) has one of the world's worst TB epidemics driven by HIV. The WHO has identified 22 high-burden countries (HBCs), which account for 81% of all estimated incident TB cases globally. Among the HBCs, SA has the third highest absolute number of reported incident cases and the fifth highest number of estimated prevalent (undiagnosed active TB) cases. [1] After adjusting for population size, SA has the highest incidence and prevalence of TB among the HBCs. It also has the largest number of HIV-associated TB cases and the second-largest number of diagnosed multidrugresistant (MDR)-TB cases (after India). [1] The National Tuberculosis Programme (NTP), established after SA became a democracy in 1994, faced the challenge of integrating TB services into weak primary healthcare systems and the emergence of the HIV epidemic, which led to TB case rates quadrupling between 1994 and 2012 (Fig. 1). [2] The growing burden of MDR-TB and the emergence of extensively drug-resistant (XDR) TB in 2006 added a further burden to overstretched health services. In order to respond to the dual epidemics of HIV and TB rationally, SA developed an integrated National Strategic Plan (NSP) for HIV, STIs and TB (2012-2016). [3] The targets set in the NSP for TB are to halve TB incidence and mortality by 2016 and to have no new TB infections, deaths or stigma by 2032. In this review we highlight successes and challenges in TB prevention, treatment and care and discuss strategies to achieve the NSP targets.
Tuberculosis Prevention in South Africa
PloS one, 2015
South Africa has one of the highest per capita rates of tuberculosis (TB) incidence in the world. In 2012, the South African government produced a National Strategic Plan (NSP) to control the spread of TB with the ambitious aim of zero new TB infections and deaths by 2032, and a halving of the 2012 rates by 2016. We used a transmission model to investigate whether the NSP targets could be reached if immediate scale up of control methods had happened in 2014. We explored the potential impact of four intervention portfolios; 1) "NSP" represents the NSP strategy, 2) "WHO" investigates increasing antiretroviral therapy eligibility, 3) "Novel…
What did we learn from South Africa’s first-ever tuberculosis prevalence survey?
2021
The World Health Organization (WHO) has urged countries to conduct tuberculosis (TB) prevalence surveys to better understand the burden of TB and to enable the WHO to conduct global estimates. Until the report from the first-ever prevalence survey in South Africa (SA), the country had to rely on WHO estimates. The recently published report on the SA TB prevalence survey provides important estimates of the burden of TB disease as well as information on health-seeking behaviour. This review notes the key findings of the 2018 prevalence survey. The high prevalence of TB in SA continues to be a major cause for concern, and calls for a significantly improved response to reach the End TB targets set by the WHO.
Regional changes in tuberculosis disease burden among adolescents in South Africa (2005–2015)
PLOS ONE, 2020
Background Adolescents in the Western Cape Province of South Africa had high force of Mycobacterium tuberculosis (MTB) infection (14% per annum) and high TB incidence (710 per 100,000 person-years) in 2005. We describe subsequent temporal changes in adolescent TB disease notification rates for the decade 2005-2015. Method We conducted an analysis of patient-level adolescent (age 10-19 years) TB disease data, obtained from an electronic TB register in the Breede Valley sub-district, Western Cape Province, South Africa, for 2005-2015. Numerators were annual TB notifications (HIVrelated and HIV-unrelated); denominators were midyear population estimates. Period averages of TB rates were obtained using time series modeling. Temporal trends in TB rates were explored using the Mann-Kendall test. Findings The average adolescent TB disease notification rate was 477 per 100,000 for all TB patients (all-TB) and 361 per 100,000 for microbiologically-confirmed patients. The adolescent all-TB rate declined by 45% from 662 to 361 per 100,000 and the microbiologically-confirmed TB rate by 38% from 492 to 305 per 100,000 between 2005-2015, driven mainly by rapid decreases for the period 2005-2009. There was a statistically significant negative temporal trend in both all-TB (per 100,000) (declined by 48%; from 662 to 343; p = 0�028) and microbiologically confirmed TB (per 100,000) (declined by 49%; from 492 to 252; p = 0�027) for 2005-2009, which was not observed for the period 2009-2015 (rose 5%; from 343 to 361; p = 0�764 and rose 21%; from 252 to 305; p = 1�000, respectively).
American Journal of Respiratory and Critical Care Medicine, 2010
Rationale: In 2005, we reported high prevalence of untreated pulmonary tuberculosis (TB) in a South African community. Prevalent untreated TB is the main source of transmission. In settings with large burdens of human immunodeficiency virus (HIV) and TB, highly active antiretroviral therapy (HAART) may contribute to TB control. Objectives: To assess the community-level impact of HAART on TB prevalence, we repeated a community-based TB prevalence crosssectional survey in 2008 following HAART roll-out. Methods: A random 10% adult population sample was identified from the community. Participants provided two sputum specimens for acid-fast bacilli microscopy and TB culture. Oral transudate specimen was collected for anonymous HIV testing, linked to TB diagnosis. An interviewer-administered, structured questionnaire identified TB and HIV history and risk factors. Measurements and Main Results: In the 2008 survey, 1,250 adults participated (90% response rate); 306 (25%) tested HIV positive, of which 60 (20%) were receiving HAART. A total of 20 TB cases were identified (12 receiving TB treatment), representing a significant decline in prevalence from 3.2 to 1.6% (P 5 0.02) between the surveys. TB prevalence in participants not infected with HIV was unchanged (P 5 0.90). The decline occurred among participants not infected with HIV, decreasing from 9.2 to 3.6% in 2005 to 2008, respectively (P 5 0.003). In participants infected with HIV, prevalence of treated TB declined from 4 to 2.3% (P 5 0.06), and untreated TB prevalence from 5.2 to 1.3% (P 5 0.02). The proportion of untreated TB in patients receiving HAART decreased significantly, from 22 to 0% (P , 0.001). Conclusions: Prevalence of undiagnosed TB declined significantly over a period of increasing HAART availability. The decline was predominantly in individuals infected with HIV receiving HAART.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021
BACKGROUND Few studies have evaluated tuberculosis control in children and adolescents. We used routine tuberculosis surveillance data to quantify age- and HIV-stratified trends over time and investigate the relationship between tuberculosis, HIV, age and sex. METHODS All children and adolescents (0-19 years) routinely treated for drug-susceptible tuberculosis in South Africa and recorded in a de-duplicated national electronic tuberculosis treatment register (2004-2016) were included. Age- and HIV-stratified tuberculosis case notification rates (CNRs) were calculated in four age bands: 0-4, 5-9, 10-14 and 15-19 years. The association between HIV infection, age and sex in children and adolescents with TB was evaluated using multivariable logistic regression. RESULTS Of 719,400 children and adolescents included, 339,112 (47%) were 0-4-year-olds. The overall tuberculosis CNR for 0-19-year-olds declined by 54% between 2009 and 2016 (incidence rate ratio [IRR]=0.46, 95% confidence interv...