The COVID-19 pandemic has had a devastating impact on tuberculosis (TB) in South Africa, with National Health Laboratory Service (NHLS) diagnoses and case notifications dropping by 35% to 40% within the first six months due to the lockdown.
“As a clinician, I can also tell you that we cannot address a disease unless we sufficiently understand its epidemiology and have data to effectively combat it,” said Health Deputy Minister, Dr Sibongiseni Dhlomo, on Tuesday.
The Deputy Minister was speaking during the opening plenary of the 7th SA TB Conference in Durban.
“A basic question to start with, why does the disease continue unabated, despite the remarkable biomedical progress we have had in the past decades? It is well known that tuberculosis is a by-product of poverty.”
According to Dhlomo, most countries with a high burden of TB are impoverished nations.
He believes that the first step to addressing the prevalence of TB is to stop thinking of only biomedical solutions.
“TB is a social disease made worse by poor political will and commitment to its control. I strongly believe TB control needs to be taken up by all of us as a developmental issue.
“I would also say that the responsibility of TB control needs to move from doctors to medical administrators and politicians. We need to tackle tuberculosis with the same audacity we amassed to fight COVID-19.”
Dhlomo said the people afflicted by TB, often known as “a disease of the poor”, are among the most disadvantaged.
“We need sound research to make meaningful strides and improve the experience of our TB clients.”
Shifting his focus to COVID-19, he said the disease claimed over 102 000 lives in South Africa, with 92 000 people having died by the end of 2021.
Meanwhile, the World Health Organisation (WHO) estimates that over 110 000 people were killed by TB in the country between 2020 and 2021.
Since 2010, over one million South Africans are said to have succumbed to the infectious disease.
Currently, South Africa is one of the high-burden countries for TB, HIV-associated TB, and drug-resistant TB.
“Year after year, we look at statistics and somehow, we have become immune to this reality. Behind these numbers are human individuals, families and communities facing unthinkable tragedies afflicted by a disease that is perfectly preventable and curable.”
He acknowledged that solutions offered are often complicated, tedious and timid, which compounds the problem.
“I fear tuberculosis control may become a victim of this timid thinking and actions. Perhaps the COVID-19 pandemic was a rude awakening for us. History also tells us that bold and audacious steps offer the greatest opportunity for success. For TB, that is the only hope.”
Outlining government’s TB Recovery Plan, Dhlomo said the programme is target-driven and evidence-based, and is aimed at finding people with undiagnosed TB, strengthening the linkage of diagnosed people to treatment, and strengthening care and prevention.
Dhlomo said there are new interventions in the pipeline, including expanded screening activities with the TB Check app, as well as the use of digital chest x-ray for screening.
“Using an SMS to provide patients with their TB results is also being introduced to link people to care faster, and save people the trouble and cost of returning to the clinic when unnecessary.
“We are also planning to introduce more patient-friendly treatment regimens such as four-month paediatric drug-susceptible and six-month drug-resistant TB regimens to improve retention in care.”
In addition, he said government is planning to scale up the implementation of TB preventive therapy, including 3HP, three months of weekly rifapentine and isoniazid oral treatment, to improve TB prevention and reduce transmission, especially among people staying in the same home as someone who recently developed TB.
“Over the next five years, we will work toward a system that supports people from the moment they come into contact with a health provider – public, private or traditional – to know their test result and link to care within a week.”
