Over half-a-million South Africans died from TB in eight years

More than half-a-million people in South Africa died from tuberculosis (TB) between 2015 and 2023, a staggering toll for a disease that has been treatable for decades.

Delivering the state of TB in South Africa before parliament on Tuesday, health minister Dr Aaron Motsoaledi said the country continues to lose thousands of lives each year despite advances in treatment and access to care.

In 2023 alone, one in five people diagnosed with TB died, a case fatality rate of 22%, translating to 56,000 deaths out of 270,000 people who contracted the disease.

“Tuberculosis has killed more people than all the known pandemics, past and present, combined. TB has been a treatable disease for the longest time. Many pandemics for which there was no treatment came and went, yet TB, which can be treated, remains,” he said.

Motsoaledi’s remarks followed the relaunch of the South African TB Caucus, part of a global initiative to mobilise parliamentarians in the fight against TB by fostering access to services, research and resource mobilisation among key stakeholders.

TB and inequality: a deadly combination

The minister said while TB-related deaths among people living with HIV have declined by 31%, deaths among those without HIV have risen by 25%.

“The human cost extends beyond lives lost. More than half of households affected by TB face catastrophic costs. TB continues to deepen poverty and illness in our communities.”

According to the South African TB Patient Cost Survey, 56% of TB patients experience catastrophic costs, despite treatment being free in public health facilities. These costs arise from out-of-pocket medical expenses, non-medical costs such as transport and food, and income losses due to missed work.

The report warns that these financial pressures often lead to poor treatment outcomes, household instability, and relapse, as families are forced to choose between survival and care.

Earlier in the day, Sheila Xego, caretaker chairperson of parliament’s portfolio committee on health, said TB is not just a health crisis but a social and economic challenge. “It thrives where people are poor, overcrowded and unheard,” Xego said.

She said the responsibility cannot rest with the department of health alone; it requires every part of government, every sector and every community.

Finding the missing TB patients

The department of health has vowed to intensify the fight against TB by increasing the number of people tested for the disease to 5-million over the next 12 months, from 2.7-million in 2023.

The initiative aligns with the National Strategic Plan (NSP) for HIV, TB and STIs 2023–2028, which aims to build resilient health systems and remove barriers to effective prevention, testing and treatment.

Dr Thembisile Xulu, CEO of the South African National AIDS Council (Sanac), said the country is now at the mid-term mark of the five-year plan, making it crucial to translate targets into lives saved.

“We must find and treat the missing TB patients to close the gaps between testing, diagnosis and treatment initiation,” Xulu said.

Treatment success and ongoing challenges

Motsoaledi reported that as of 2023, 79% of the 270,000 people with TB in South Africa had been identified and placed on treatment.

“To end TB, we must identify every person living with the disease, treat them and, most importantly, cure them. This will help us break the chain of transmission in our communities,” he said.

The treatment success rate for drug-sensitive TB now stands at 83%, while the newer six-month regimen for multidrug-resistant TB (MDR-TB) has achieved success rates of between 75% and 80%.

However, loss to follow-up remains a concern, with 8% of drug-sensitive TB patients and 9% of those with drug-resistant TB discontinuing treatment. Motsoaledi noted that children and adolescents are particularly underrepresented in TB notifications, accounting for only 10% of all cases.

“The fight against TB cannot succeed without the role of parliament and the National TB Caucus,” Motsoaledi said. “You are closest to the people in your constituencies. You can help reduce stigma, encourage early testing and support TB patients and their families.”