SEATTLE, Washington — In the past decade, South Africa has made tremendous strides towards decreasing the incidence of tuberculosis. Despite this, however, the disease remains the largest contributor to death in the country. That is why both the U.N. and the South African government are making it their mission to bring an end to the disease. Here is what to know about the response to tuberculosis in South Africa.
Strategic Response to Tuberculosis
In 2015, the U.N. announced its Sustainable Developmental Goals (SDG) for 2030. Among them was the eradication of the Tuberculosis epidemic that currently plagues the developing world. In particular, the U.N. aims to reduce TB deaths and incidence by 90 percent and bring costs attributed to the disease to zero by 2030. Two of the main challenges to dealing with TB internationally are the development of multi-drug resistant tuberculosis and the inability of many to receive needed treatment.
As for South Africa, the country’s National Strategic Plan for HIV, TB, and STIs 2017-2022 heavily concentrates on the parallel epidemics of HIV and TB. Those suffering from HIV account for 63% of new TB diagnoses in the country and as a population bear the heaviest burden of the disease.
Thus, in order to have a community-centered response, South Africa is making use of newly available technology. Geospatial mapping will be used to concentrate efforts in 27 districts that account for 82 percent of all new HIV infections and 19 districts that have the highest TB burden. This will allow health workers to focus on reducing barriers to care and service uptake in the places that need them most.
Treatment of Tuberculosis in South Africa
The majority of health services for tuberculosis in South Africa are provided by the public health sector. This allows those affected to receive diagnostic and treatment services free of charge. Despite having a robust infrastructure for providing services, however, only 52 percent of people diagnosed with TB complete the treatment regimen.
In order to optimize its response to TB, South Africa uses a care cascade framework, which tracks stages of needed medical intervention during treatment. Additionally, by aiding in surveillance and data collection, the framework also allows officials to analyze gaps in the country’s strategic response to the disease. On a practical level, this can mean pinpointing which key populations are being overlooked.
Existing familiarity with the framework among South Africans carries its own benefits as well. Previously, South Africa had utilized care cascade to address program challenges with HIV mother-to-child transmission and ARV treatment services, making it easier to find ready-trained professionals.
The Future of Tuberculosis in South Africa
As of 2018, South Africa has an estimated 19,000 cases of multidrug-resistant (MDR) tuberculosis. On a per capita level, that is enough to give the country the unfortunate distinction of having the largest number of cases worldwide. However, while tackling drug-resistant TB will be a major challenge to achieving national goals, there is hope.
Within the past five years, health professionals have developed a clearer understanding of MDR diagnostic tools and treatment options. Furthermore, strengthening political commitment among South African leaders toward ending the epidemic is encouraging. This progress will aid in obtaining additional funding and awareness of where to direct prevention efforts for MDR and XDR, which will be even more essential in a resource-constrained setting.
While tuberculosis in South Africa remains a major issue, national efforts have decreased the number of deaths attributed to the disease. From 2007 to 2017, the number of deaths from tuberculosis decreased by 48 percent. While whether South Africa will meet the U.N.’s sustainable development goals or not remains up in the air, the country continues to make impressive progress.
– Danielle Barnes