148 people die of tuberculosis (TB) daily in South Africa. According to the  South African TB survey, South Africa is one of thirty high burden TB countries that contribute to 87% of estimated incident cases worldwide.

Speaking at the opening of the 8th SA TB Conference in Durban yesterday, Health Deputy Minister, Dr Sibongiseni Dhlomo said poverty, inequality and undernutrition remain the primary drivers of South Africa’s TB epidemic.

The solution, he says, is a multifaceted approach that includes improved diagnostic tools, better healthcare worker training, enhanced patient tracking systems, stigma reduction and lowering of financial barriers associated with treatment.

“One major issue is the inadequate testing for people living with TB, which hampers early diagnosis and treatment. This problem is mostly common in children, where case finding is limited due to health worker uncertainty and the difficulty of obtaining samples from young patients,” he says. 

Another critical challenge is a high loss to follow-up, (patients who are unreachable) caused by healthcare access barriers, lack of transport for patients and limited tracking capabilities. 

“These issues prevent many patients from completing their treatment, which is crucial for both their health and the broader public health effort. Low treatment adherence remains a significant obstacle, influenced by stigma, catastrophic costs, clinic congestion, misunderstanding of TB, conflicting health beliefs, and substance use,” says Dhlomo.

Solutions to South Africa’s TB burden

Steve Letsike, South African National Aids Council (SANAC) deputy chairperson says TB is a social challenge that cannot be defeated through biomedical interventions only. 

Letsike says much like HIV, TB requires a multisectoral and community centred approach. “We need to change our TB management approach to be more holistic by engaging multi-sectoral stakeholders at every stage of the elimination process in order to make positive change. We also need to bring the lab closer to patients and enable a test and treat approach in one visit,” she says. 

She stresses that the TB conversation must be kept alive.

“We cannot be bystanders when people are dying of TB, we must be clear on our position regarding our response to the disease. We need to have a plan on how to address disparities that still exist in the TB programme,” she says. 

Dhlomo says the department is prioritising high burden populations and regions to ensure that resources are directed where they are most needed. 

The national TB survey revealed high prevalence among men, young adults aged 15-24 years and HIV positive individuals.

Dhlomo says improved TB social and  behavioural change communication is crucial for enhancing TB programming. 
“We have crafted user-friendly TB dashboards accessible to TB program managers at every level of the health system,” he says. –Health-e News