Tuberculosis (TB) is still the leading cause of death in the country, even though this is on the decline. According to the World Health Organisation’s latest Global Tuberculosis Report, South Africa has one of the highest rates of new infections, but the country is also good in lowering the overall numbers. 

Government efforts include free testing and TB treatment for children and adults, which are available at clinics around the country.

Understanding and monitoring the disease, and developing better treatments is crucial in fighting the epidemic, and makes our research capacity vital. 

Promising breakthroughs

Dr Emily Wong from the Africa Health Research Institute (AHRI), Massachusetts General Hospital and Harvard Medical School, says “TB research in South Africa has had very exciting results.” She describes last year’s first positive finding on a TB vaccine trial as a “true milestone.”

Another highlight was the 2019 study results from the Aurum Institute which indicates that a shorter regime preventative TB therapy can be safely combined with HIV-treatment. 

Professor Martie van der Walt, the Director of the Tuberculosis Platform at the Medical Research Council (SAMRC), says that South Africa’s high HIV-burden, with around 60% of TB patients having both diseases, mean that our researchers are particularly skilled at looking at this important patient population.

South Africa was also the first to roll out bedaquiline in its national programme, which a statement from the research team at Stellenbosch University says is “the first new anti-tuberculosis drug to be developed in four decades” and offers hope for the survival of multidrug-resistant TB patients.

The country’s research legacy also finds its way onto drug labels. A new multi-drug-resistant TB drug was called pretomanid because a lot of the development took place in Pretoria. It has recently been given preliminary approval by the American FDA. 

The research is not just aimed at developing treatments but understanding the problem. For instance, the SAMRC has conducted several important surveys, including the National Tuberculosis Prevalence Survey, which is set to be released later in the year. It aims to give an updated view of how common TB really is and inform responses to the epidemic. 

While understanding the wider context is crucial, projects like AHRI’s Vukuzazi programme look at particular communities to learn from them. The institute did a mass screening of communicable and non-communicable diseases in a particular district’s population and found a high level of people with asymptomatic TB. 

Wong says this “puts a different light on our ability to control the TB epidemic if we keep doing what we’ve always done, which is wait for patients to come to the clinic and then put them on treatment.”

Van der Walt says the local research success is because the country has some of the world’s top TB researchers, and that our mature infrastructure in universities and research councils means that “there is a very good established system for doing high quality research.”

Wong says this is positive not only for its impact on wider research, but the training of younger researchers in the country. 

The way forward

These breakthroughs, while commendable, continue to be highly needed. According to the National Institute for Communicable Diseases, “approximately 600 people are diagnosed with active TB each day in South Africa.” Apart from the rate of co-infection with HIV and the challenge of drug-resistant TB, poor nutrition linked to poverty can increase vulnerability for the disease. 

Research funding remains lower than needed according to one analysis, even though there have been various political moves and commitments to change this locally. Funding often comes from local sources like the SAMRC, the Department of Science and Technology and the National Research Foundation, while international funders and co-funders include the Bill and Melinda Gates Foundation.

Covid-19 impact on TB

Wong cautions that the current Covid-19 pandemic does influence our TB population and will affect the capacity of the health system overall. She says, “it is an urgent research question” to now understand how it will impact patients, and how TB health services will be preserved. The SAMRC has committed to research into Covid-19, including the link to TB. 

As the fight against the TB epidemic continues, funding and support of research is fundamental in understanding the disease and treating it effectively. While that is a big challenge, South Africa’s track record in the field provides some hope.-Health-e News