Tuberculosis (TB), an ancient but curable disease, kills more people worldwide than any other infectious disease. Despite decades of global efforts to fight TB, more than 1.6 million people die from the disease annually, and the rate of decline in new infections is too slow to place the world on the path to ending the epidemic as a public health threat by 2030. 

In South Africa, fewer than half the estimated 328,000 people with TB in 2021 were successfully treated. Almost 120,000 people with TB had not been diagnosed and/or initiated on treatment, and more than 70,000 of those on treatment did not complete the full six-month course of treatment. 

The World Health Organization estimates that 55,000 people died from TB in South Africa in 2021. The high prevalence of HIV, socioeconomic risk factors such as poor nutrition and overcrowding, and poor health-seeking behaviour all contribute to the picture. 

The limitations associated with current drugs, diagnostics and vaccines can’t be excluded. However, it is encouraging to witness the recent investments in TB research and development (R&D) in new tools that could fundamentally change how we detect, treat and prevent TB, thus dramatically transforming the TB fight.

While there is a long way to go, there has been important progress in South Africa’s response to tuberculosis and 2023 is set up to be a watershed year for the fight against the disease both globally and in South Africa. (Photo: GCIS / Spotlight)

For the first time in history, funding for TB R&D hit $1-billion worldwide in 2021, marking a significant milestone. However, this investment still falls significantly short of what’s needed to achieve the United Nations’ Sustainable Development Goal of ending TB by 2030. 

SA at the centre

South Africa plays a central role in TB R&D and the country is benefiting from these efforts. A new TB preventive therapy treatment is being introduced. Xpert MTB/RIF, a molecular diagnostic test for TB that is being scaled up globally, has been available for almost a decade as a first-line TB test in South Africa.

National guidelines are being amended to provide BPAL (bedaquiline, pretomanid and linezolid), which is a shorter, six-month, all-oral regimen, as the new standard of care for DR-TB.

The M72/AS01E TB vaccine is advancing to a phase III trial in South Africa, with promising preliminary results. This development, in particular, is significant given that the only currently used TB vaccine, BCG, is over 100 years old and not very effective.

The South African health system has also made progress over the past year to recover from Covid losses through the implementation of the National TB Recovery Plan. TB testing in 2022 was 25% higher than in 2021, reversing the declining testing trends seen in the pre-pandemic era. However, challenges remain with linkage and retention in care.

‘A watershed year’

This year is a watershed year globally and in South Africa. After the 2018 UN General Assembly High-Level Meeting on TB, 2023 will be the first time the global health community and governments will gather to review progress and make new commitments to work toward TB elimination.

In South Africa, the launch of the fifth National Strategic Plan (NSP) for HIV, TB and STIs titled “The People’s NSP”, for the period 2023-2028, provides renewed hope. 

Now more than ever, we need to work in partnership to bridge the gaps and explore stronger public-private partnerships to ramp up investment to ensure better access to quality TB prevention, diagnosis and care services.

This will only be realised if we all commit to the NSP’s success.

We look to the Deputy President, in his capacity as the chairperson of the South African National Aids Council, to lead the multisectoral response. This is critical to address the socioeconomic determinants of TB. 

Community healthcare workers are the key to decentralising TB services closer to where people live. (Photo: Médecins Sans Frontières (MSF) / Spotlight)

We call on all provinces to strengthen the implementation of services, to monitor and evaluate their plans, and to take corrective action to ensure that targets are met.

We look to all healthcare workers to provide quality testing and treatment to people with TB, free of stigma and discrimination. We need to reach more people who are infected with TB. The new TB testing strategy, which requires health workers to test every person living with HIV, all household contacts, and persons with previous TB annually irrespective of symptoms, provides an opportunity to do this.

We call on communities and their leaders to use their networks to convey messaging about TB.

We call on every person who is coughing or losing weight or has a fever or night sweats to access free TB tests at a government clinic. We call on communities and activists to hold providers accountable for the NSP commitments.

As we commemorate World TB Day on Friday, 24 March, let us all pledge to make this year’s theme a reality – “Yes! You and I can end TB.” DM/MC

Tanna is senior programme officer, TB, South Africa at the Bill & Melinda Gates Foundation (BMFG) and Pillay is a professor at the Division of Public Health and Health Systems, Stellenbosch University, and a former deputy director-general at the National Health Department. 

Note: One of the authors of this op-ed is an employee of BMGF. Spotlight receives funding from BMGF, but is editorially independent – an independence that the editors guard jealously. The views expressed in this op-ed are not necessarily those of Spotlight.

This article was published by Spotlight – health journalism in the public interest.