South Africa and Tuberculosis
August 5, 2011
A delegation from the Center for Strategic and International Studies (CSIS) Global Health Policy Center will be traveling to South Africa in August, 2011 to look at the major efforts underway to renew the United States’ bilateral relationship with South Africa, with a particular focus on creating sustainable partnerships in health and other areas of U.S. foreign assistance. South Africa is a leading strategic partner on development, health, and other critical issues. U.S. investments in South Africa are the single largest bilateral health account in the world. The CSIS staff will look specifcally at: The U.S.-South Africa Strategic Dialogue; South Africa's shift toward greater country ownership in the health sphere; and turning the tide on the HIV epidemic.
In the days to come, we will post blogs on the current HIV/AIDS, Tuberculosis, Maternal and Child Health, and Non-communicable diseases situations in the country. Please let us know if you questions on any of these topics that you would like our experts to answer.
South Africa has the highest tuberculosis infection rate per population and accounts for 5% of the global TB burden. TB incidence has increased threefold between from 1996 to 2006, and by 2009 there were 406,000 cases. The incidence rate is estimated at 948 per 100,000. About 1.8% of new cases are Multiple-Drug Resistant (MDR) TB and about 6.7% of retreatment cases develop MDR. South Africa has the highest TB and HIV co-infection rate in the world at 73%. Tuberculosis is a leading cause of death for people living with HIV. HIV attacks one’s immune system and makes him vulnerable to opportunistic infections. When a person infected with HIV contracts TB, latent TB infection progresses much quicker to active TB disease. While both conditions of tuberculosis are treatable for people living with HIV, special attention and awareness from health care workers are needed to prevent further complications associated with HIV-TB co-infection.
Figure 1.3: HIV Prevalence and TB Infection 1980-2006. Graph from: SACEMA Weekly
For years the TB cure rates lingered around 40-55%, but an increased awareness of the magnitude of the problem has mobilized the government’s response, and in 2009 the cure rate increased to 70%. By 2007 case detection rose to 78% and Directly Observed Therapy Short course (DOTS), an internationally recommended TB treatment strategy, achieved a success rate of 74%. The primary targets of South Africa’s Strategic Plan for Tuberculosis (2007-2011) are: 70% case detection rate, more than 85% treatment success rate and 85% cure rate. Case detection and continued follow-ups are important for financial reasons as well. For ordinary TB, the South African government spends R400 per person. But when the patient fails to adhere to the treatment routine and develops a MDR TB, the cost of treatment increases to R24, 000.
To further progress, in March 2011, South Africa announced a three-pronged strategy to deal with TB.
1. Use of the new GeneXpert technology for better diagnosis of TB and multidrug resistant TB.
2. Active case finding to trace those who came in contact with TB patients via household visits.
3. Opening of nine specialty hospitals to treat MDR-TB patients.
- South Africa and HIV/AIDS
- South Africa and Maternal Child Health
- South Africa and Non-Communicable Diseases
- Healthy Dialogues Blog, August 2011: South Africa