With less than five years remaining to achieve the United Nations Sustainable Development Goals, South Africa faces a critical challenge: ending the tuberculosis (TB) epidemic. The goal is ambitious: an 80% reduction in TB incidence and a 90% decline in TB deaths compared with 2015 levels.
While South Africa has made remarkable strides, halving the number of TB patients between 2015 and 2023, the mortality rate has only decreased by 15%. A significant portion of TB sufferers face catastrophic financial burdens, pushing them deeper into poverty.
Key barriers to effective TB control
Late Diagnosis:
Financial Constraints: High out-of-pocket expenses for care, transport, and lost income deter patients from seeking timely treatment.
Poor Health-Seeking Behaviour: Initial TB symptoms are often overlooked, leading to delayed diagnosis and increased disease severity.
Stigma: Fear of discrimination prevents many from seeking care.
High HIV Co-infection: Approximately half of people with TB in South Africa also have HIV, significantly increasing the risk and complexity of treatment.
Asymptomatic TB: Many TB cases are asymptomatic, making early detection challenging.
To address these challenges, South Africa is implementing innovative strategies:
Targeted Universal TB Testing (TUTT): This approach involves routine TB testing in high-risk individuals, regardless of symptoms, leading to increased diagnosis.
Community-Based Active Case Finding: Screening and testing individuals in high-burden communities, particularly those with HIV, household contacts of TB patients, and those living in poverty.
Digital Chest X-rays (DCXR): Utilising DCXR technology for community screening offers a potential alternative to symptom-based screening.
Investing in the Future
TB Vaccine Development: Promising TB vaccine candidates are currently in clinical trials, offering hope for improved prevention.
Advanced Diagnostics: Developing low-cost, point-of-care diagnostics will enable faster diagnosis and treatment initiation.
Shorter Treatment Regimens: Research is underway to develop shorter and more effective TB treatment regimens, which will improve patient adherence and reduce the risk of drug-resistant TB.
Reaching the ambitious End TB targets requires a multi-pronged approach, including increased investment in research and development, strengthened healthcare systems, and community engagement. While significant challenges remain, South Africa has demonstrated a commitment to combating TB through innovative strategies and a focus on early detection and treatment.
- Dr Pillay is the director for HIV and TB delivery at the Bill and Melinda Gates Foundation, and Tanna is the senior programme officer for TB.