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Opinionista

TB is a killer and time is running out to deliver quality care to patients

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Dr Zameer Brey is the TB Programme Lead for South Africa at the Bill & Melinda Gates Foundation.

Tuberculosis is the world’s ticking time bomb. It is time to heed the call made by South Africa’s President Cyril Ramaphosa and Rwanda’s President Paul Kagame: We must all work together to eliminate tuberculosis by 2030.

Despite being a preventable, treatable and curable disease, tuberculosis is the world’s biggest infectious killer. Every year, 1.6 million people die globally from the disease, including 78,000 South Africans. World TB Day was held on March 24, 2019, and I am optimistic that by using data to improve testing and treatment services for TB and holding leaders accountable for results, we can significantly reduce the number of South Africans who succumb to the disease in the future.

South Africa has been at the forefront of global efforts to end TB. The government has rolled out new drugs and diagnostics such as bedaquiline and GeneXpert and has been a key partner for promising TB vaccine trials, including the BCG revaccination study and M72 trial. We need new tools to better diagnose, treat and prevent TB, but these will require investments in research and years to develop. There are several steps we can take now, starting at the facility level, to reduce the number of South Africans who die from TB.

I recently visited a primary health care facility in Msunduzi, an area close to the epicentre of the TB and HIV epidemics in KwaZulu-Natal. The facility was finding less than half the cases that it should have been – meaning that over half of the people living with TB in the area were “missing” from care. Using programmatic and laboratory data, an approach that was endorsed in a recent report by global TB experts published in The Lancet Global Health journal, the facility and sub-district discovered that screening methods were simply not effective. People with TB were therefore not being diagnosed timeously and not being placed onto treatment fast enough.

By providing additional training for the staff who conduct TB screenings and closely monitoring the quality of screening, the facility doubled the number of cases it found in less than six months. This is just one example of how facilities are improving quality of care and finding TB cases without additional resources. As part of a national quality improvement initiative being led by the National Department of Health, simple but effective approaches to improving quality will be scaled up across the whole country, with support from the Global Fund to Fight Aids, Tuberculosis and Malaria.

In order to make large-scale improvements in quality of care, we will need to pay close attention to data collection, data systems and analyses. As part of one of the largest health programmes in the country, the government is providing a unique health identifier to everyone in South Africa, having already issued a health ID to over 30 million South Africans. Soon, these identifiers will be linked to the national lab database and electronic patient management systems such as TIER, helping us to make sure that patients are timeously diagnosed, treated and supported.

The Department of Health has invested in data systems like these in the Western Cape for over a decade, with great success. Coupled with the right political will, we can scale up key aspects of this model in other provinces in less than a year.

Speaking of political will, our leaders have promised to make great progress against TB. In September 2018, at the first-ever United Nations High-Level Meeting on Tuberculosis, President Cyril Ramaphosa joined Rwandan President Paul Kagame to urge heads of state around the world to make ending TB a global priority. Their call to action was clear: we must work together to find and provide diagnosis and treatment to 40 million people with tuberculosis between 2018 and 2022, and end TB by 2030.

Now is the time to hold all leaders, from President Ramaphosa to our local health officials, accountable to making these goals a reality by ensuring that they take action to improve TB services and make them accessible to more people. Rather than developing new ways to do this from scratch, we can use structures already in place in South Africa – clinic committees, district health committees, provincial Aids councils, civil society groups and the new South African chapter of the Global TB Caucus – to build a strong accountability framework for TB and HIV that will ensure all the promises and commitments made are delivered.

As the clock ticks quickly towards national and global goals to end TB, there is no excuse to delay action in South Africa. We can, and must harness the collective voice of patients, politicians and community leaders to ensure that facilities, districts and provinces continue to use the data to improve their services and ultimately meet their targets for TB and HIV.

An accountability framework that starts at facilities and cascades upwards will ensure that the elimination of TB remains top of mind and heart. DM

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