Tuberculosis (TB) experts in South Africa are concerned about the slow uptake of TB preventive treatment (TPT). 

The people most at risk of TB disease aren’t receiving the protection they need. Dr Norbert Ndjeka, Chief Director of TB Control and Management at the National Department of Health, agrees that uptake has been slow, despite these essential medicines being available in the country.  

Tuberculosis (TB) is a leading cause of death in South Africa. The World Health Organisation (WHO) Global Tuberculosis Report 2022 estimates that around 304 000 people in South Africa fell ill with TB and 56 000 died from it in 2021.

TB infection is common. Most people infected with TB won’t show symptoms or get ill – this is known as latent TB. But latent TB can progress to active TB disease which causes illness in the individual and can be passed on to others. 

The best way to stop the progression to active TB is by giving people treatment. This is known as TB preventive treatment (TPT).  

According to Dr Lucy Connell, TB Programme Lead at Right to Care, there’s been increased uptake of TPT among people with HIV and children living with TB over the past years. But it is concerning that many eligible people have still not received the treatment – especially people with HIV.

“In 2021, South Africa reported that only 63% of HIV positive people who were newly enrolled in care received TPT while 57% of eligible child contacts under five years received TPT,” says Connell.

Expanded coverage

Esther Cass, Doctors Without Borders (MSF) senior HIV/TB Advisor, says: “People with weak immune systems, especially people living with HIV have much higher risk of developing TB disease. Other risk factors to develop TB disease are for example, children and adults with malnutrition or other conditions that weaken the immune system.” 

Previously, only people with HIV and children under five-years old could get TPT.  But under the new National Guidelines on the Treatment of Tuberculosis Infection published earlier this year, more people now qualify to receive preventive treatment.

Among the people who are now eligible for TPT are: 

• All people (regardless of age and HIV status) after significant TB exposure
• All people who are immunocompromised, including people with diabetes, people on dialysis, as well as those preparing for organ transplant.
• People with silicosis.

“Most people are still not aware of the availability of TPT for this extended group of people who are at risk of developing TB. But we are calling for everyone who qualifies to receive TPT to consider doing so as we all know that prevention is always better than the cure,” says Ndjeka.

TB preventive treatment is available at most public health facilities around the country. Eligible populations can ask their healthcare providers for the medication.  

Ndjeka says the department will increase awareness around the programmes. And he remains hopeful that the coverage will increase as the year progresses. 

More can be done to fight TB

Despite the roll-out of TPT, connell says that the country can still do more in terms of TB prevention and control.

“Modelling work conducted showed that a combination of interventions implemented at scale is required to reach the 2025 End TB strategy targets of reducing the TB incidence by 50% and the TB mortality by 75%,” says Connell.

To this end, the government’s new guidelines also expand screening and testing for TB to people who are not yet showing any symptoms of the infectious disease. 

“In addition to prevention, we also need to identify and treat TB. So we really want people to take TB tests so that we are able to find those who have TB as early as possible and start them on treatment early. This is another way of decreasing the TB transmission among our communities,” says Ndjeka.-Health-e News.