Western Cape health authorities to test everyone at high risk of TB

The Western Cape health department says it will start testing people at high risk of contracting tuberculosis, whether or not they show symptoms, as it battles to beat the epidemic. 

Health MEC Nomafrench Mbombo said over the next three years (2023-2026) the province will introduce targeted universal testing (Tutt) for people considered to be at increased risk of TB, including those who have had TB before, households of TB contacts, HIV-positive people and those living in overcrowded communities.

Despite being recognised for its healthcare services, the Western Cape remains one of the overburdened provinces for TB, with a higher prevalence than the national rate of 615 cases for every 100,000. The other two badly affected provinces are KwaZulu-Natal and the Eastern Cape. 

TB is in the spotlight as World TB Day is commemorated across the globe on Friday.

According to the World Health Organisation (WHO), about 360,000 people in South Africa fall ill with TB each year. It’s estimated that between 120,000 and 150,000 are never diagnosed. 

Mbombo said the Tutt strategy would be implemented in communities through support from NGOs in seven high-burden TB districts and subdistricts.  

“It will see everyone at high risk of TB receiving a TB test after they have been in close contact with a person diagnosed with TB or on TB treatment in the past year, irrespective of TB symptoms,” she said.  

In 2020 research showed such a strategy can help diagnose more people quickly. In South Africa, Tutt was found to have improved TB case detection by 17%.

Mbombo said another step the Western Cape is taking to reduce TB cases is ensuring rapid diagnosis, early initiation of and adherence to treatment.   

“Currently, three districts ... the Southern Western, Garden Route and Overberg, are implementing a community-based pilot project focusing on TB screening and TB contact tracing, as well as TB sputum collection at community level and linkage to the nearest healthcare facility.” 

From October to December 2022, the project screened 6,323 clients and tested 1,844, with 73 testing positive and linking to care. “Without this intervention, these 73 clients may not have been found and initiated on TB treatment and contributed to the spread of TB infection in the community.” 

Through these interventions the province aims to not only meet but exceed global and local commitments to end TB by 2035.  

Key indicators show us that to date:    

• The percentage of patients who tested positive for TB and were started on treatment is 78%;  
• The TB treatment success rate is 73%;   
• The rate of successfully treating patients with multidrug-resistant TB is 50%;  
• The death rate is 5% for drug-sensitive TB, while the death rate of drug-resistant TB is almost three-fold that at 14%. 
• The rate of TB patients lost to follow-up is 21%. 

Meanwhile Stop TB Partnership, a UN body aiming to eradicate TB globally, says its preliminary data shows that in 2022 the gap between the estimated number of people with TB and those diagnosed and treated was the lowest ever, with less than 3-million missing people with TB across the world. This gap was 3.2-million in 2019, 4.3-million in 2020, and 4.2-million in 2021. 

Stop TB said in 2022, several of the high TB-burdened countries — including Brazil, Nigeria, India and Indonesia — diligently increased the number of people diagnosed and enrolled on TB treatment, “reaching and exceeding the numbers seen before the Covid-19 pandemic”.  

“Despite this progress, last year, as the Covid-19 pandemic ebbed, TB regained its tragic title as the world’s biggest infectious disease killer due to setbacks in diagnosis and treatment over the past three years,” said Dr Lucica Ditiu, executive director of the Stop TB Partnership. 

She said the latest statics are crucial as the world prepares for a UN high-level meeting on the fight against TB in September. It will be the second such meeting. At the first meeting in 2018, about 15 heads of state, including South Africa, joined 1,000 participants who pledged to increase efforts to end TB. 

Ditiu said in the past few years, new tools to combat TB have cleared regulatory approvals and entered the marketplace. These innovations include: 

• Rapid molecular tests that can identify TB and resistance patterns in the bacteria; 
• Shorter treatment regimens for drug-sensitive and drug-resistant infections; 
• New digital tools, such as AI-enabled ultraportable X-ray systems for screening for TB; and 
• Vaccine candidates that have advanced to phase 3 clinical trials. 

“With the world regaining strength as the Covid-19 pandemic wanes, ending TB as a global health threat is a critically important goal. We have new innovations to help us save lives ... new diagnostic tools, shorter, less toxic treatment regimens, and new digital tools. When we add the political muscle that the UN high-level meeting will gather to the many dedicated healthcare professionals already in the front lines, ending TB looks increasingly possible,” she said. 

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