Tuberculosis is one of the major contributors to the burden of disease in Cape Town with a 74% increase in the number of reported cases over the last seven years.

Last year over 24 129 people were registered for TB treatment in Cape Town alone, 12% of the cases nationally.

Langa, with 850 patients, managed to record a cure rate of 74%, three percent higher than the city average.

Khayelitsha alone (with 8 clinics out of a total of 99 in the City) treated almost 20 percent of the TB patients in the City. Three of these clinics, Zakhele, Matthew Goniwe and Mayenzeke, improved their cure rates my more than10 percent.

The city’€™s TB manager, Dr Virginia Azevedo, ascribes the successes to the incredible commitment of nursing staff, doctors and community volunteers that educate the patients, make sure that they take their medication , submit sputum for checks and follow up on those that do not report for treatment.

In 1997, 21% of Cape Town TB patients didn’€™t complete their course of medication. This was brought down dramatically to 12% last year.

‘€œThere is not one magic recipe. At the end of the day, it is a series of little things, each contributing to a small incremental step,’€ says Azevedo.

The high burden sub-districts in the city, Khayelitsha, Nyanga and Oostenberg, account for half of the TB caseload in the city, but have also contributed significantly to the city’€™s achievements.

Khayelitsha supervises almost 2 500 TB patients, Nyanga almost 2 000 and Oostenberg over 1 500 on an average day.

In 2003, Southern and Tygerberg sub-districts achieved cure rates of above 80%.

The World Health Organisation’€™s Directly Observed Treatment Short-course (DOTS) strategy aims to cure 85% of new smear positive cases as this is the level at which the epidemic is brought into decline.

Dr Ivan Toms, director for Health in Cape Town, points out that the good results by so many clinics is proof that a lot can be achieved in spite of difficulties and huge caseloads.

He says the city’€™s success is based on good information system and rigorous monitoring able to identify problem areas, strong partnerships between the different role players, the commitment by health personnel and community-based workers and the strengthening of capacity at facility level through training and support.

City health officials also agree that all sub-districts have seen an increase in TB, but that this is particularly noticeable in places where the HIV epidemic is highest.

Patients tend to present late, health care workers delay making the diagnosis, or both.

Azevedo points out that the majority of TB cases had been coughing for a while and are highly infectious when TB is diagnosed.

‘€œBy the time they are started on treatment they have spread the infection widely. One untreated TB case will infect between 10 and 20 people a year,’€ she warns.

Again, the highest increase in caseloads has been in Khayelitsha with 66% increase. Nyanga has seen a 30%. In both districts the HIV incidence rate is also high.

Cases of extra-pulmonary (outside the lungs) TB cases have increased by a staggering 187% over the last four years. The highest reported cases are in Khayelitsha and Nyanga and HIV is again a co-factor.

Azevedo highlights that multi-drug resistant TB (MDR TB) is potentially the most serious aspect of the TB epidemic. MDR TB refers to TB, which is resistant to the two most important first line TB drugs, Isoniazid and Rifampicin.

However, a recent survey conducted by the Medical Research Council revealed that the Western Cape had the lowest rates of MDR TB in the country with reported cases in 2001 the same as in 1995 ‘€“ 1% of new cases and 4% of retreatment cases.

Statistics also revealed that about a third of TB cases are among people previously treated for TB, a proportion that has remained fairly constant.

The City has also not shied away from the positive effect a good TB programme could have in the fight against HIV and AIDS. Patients that are dually infected receive prophylactic drugs to prevent other opportunistic infections.

In 2004, all sub-districts were offering voluntary counselling and HIV testing to TB patients and 82% accepted the test.

The average co-infection rate for the region is around 50%. However the range is very wide. Khayelitsha and Nyanga have 77% and 68% co-infection rates, while Tygerberg West has a low of 16%.

 E-mail Anso Thom