14 June 2017

South Africa: TB Rates Are Coming Down, Slowly

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ASHLEIGH FURLONG writes: South Africa is making progress in its efforts to eradicate TB but much more needs to be done. This is the message from Dr Nazir Ismail, the head for the Centre for Tuberculosis at the National Institute of Communicable Diseases.

Ismail was presenting results from a study conducted between 2004 and 2015, which was published this year.

The study found that over the 12 year period, there were over 3 million microbiologically confirmed pulmonary cases of TB. However, this excludes KwaZulu-Natal for the period 2004-2010, when data was unavailable. But rates of TB are dropping. In the last three years of the study, TB cases dropped between 4 and 6% year on year.

Ismail said that this decline is about half of the global goal of a 10% annual decrease. Despite this, it is above the global year-on-year reduction of 2%.

The "END TB" strategy aims for a "world free of tuberculosis" by 2035, a goal that is "ambitious" concedes Ismail.

For this to happen, by 2020, there would need to be a 20% reduction from the 2015 baseline rate and a 90% reduction by 2035. This would mean that there are only about 10 new cases of TB in a population of 100,000.

Substantial success was seen in the study in women between the ages of 25-44, who had a 34% reduction in new cases of TB between 2008 and 2015. The report states that "these statistics link closely with the large emphasis of the HIV programme, as well as greater health-seeking behaviour among this population group".

In contrast, new cases in men in this age group decreased only by 13% for this period. The report states that specific strategies aimed at men in this age group "are urgently required if South Africa is to reach its End TB goals, including targeted public messaging, increased access through men's health and wellness centres, and male role models".

"The Antiretroviral Therapy (ART) programme is critical to the TB programme," said Ismail. "[But] a lot more behavioural work needs to be done on the TB side."

What is also needed is the targeting of TB geographic hotspots such as urban centres.

When comparing provinces in 2015, KwaZulu-Natal had the highest number of new cases, with more than 66,000, followed by the Eastern Cape at nearly 60,000 and then Gauteng at over 44,000.

Ismail drew attention to the massive decline in new cases in KwaZulu-Natal in recent years. There had also been a sharp decline in the Western Cape between 2006 and 2009, when the number of new cases plateaued out, with a small increase in 2015. It is believed that the earlier decline in the Western Cape was due to the early introduction and wide implementation of ART in the province.

In 2015, the most cases occurred in those who were male and in their 30s, with cases of TB amongst men almost consistently outstripping women, and often drastically.

In women, there has been a gradual upward shift in incidence rate in those over 65.

"This may be reflective of HIV-infected people living longer and having TB at later stages of life, as would occur in the non-HIV/AIDS population. Alternatively, this finding could reflect reactivation disease among patients who are HIV negative and were exposed during the peak incidence periods in the 1990s and 2000s," states the report.

Rates of TB in men above 65 years have also increased during the last few years of the study.

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