Bacterial diseases

Principal investigator: Dr EE Lutge (Health Systems Trust)

In collaboration with Professor JA Volmink (University of Stellenbosch) and Dr SA Lewin (Medical Research Council South Africa)

Additional technical assistance for protocol development and data analysis provided by KNCV Tuberculosis Foundation.

Funded by the National Department of Health (South Africa), the Tuberculosis Control

Assistance Program (TB CAP), (the Netherlands, through the National TB Directorate) and the Wellcome Trust (United Kingdom).

This is the sixteenth global report on tuberculosis (TB) published by WHO in a series that started in 1997. It provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care and control at global, regional and country levels using data reported by 198 countries that account for over 99% of the world’s TB cases.

We live in a time of unprecedented hope for the 33.3 million people living with HIV worldwide. Antiretroviral therapy (ART) offers the promise of a full and fulfilling life. Now people living with HIV can raise their families, work and pursue their dreams. But a thief is in our midst—one that is routinely robbing people, and the countries they live in, of their futures. Every minute, three people living with HIV have their lives snatched away by tuberculosis (TB). Africa, hit hard by HIV, is also hit hard by TB. TB is the main cause of death in people living with HIV.

This review of the Stop TB Partnership in South Africa is part of a multi-country study funded by WEMOS. The review seeks to augment the existing body of knowledge on Global Public Private Initiatives (GPPIs) in health with the aim of generating a set of country-based evidence relating to the effect of GPPIs on health policies and health systems.

In August 2000 South Africa was xperiencing one of the worst cholera epidemics in the countrys recent history. Initial reports of the cholera outbreak came from the largely rural and impoverished communities on the outskirts of the Ngwelezane Township, near the Empangeni town. The source of the epidemic was traced to the uMhlathuze River, also in the northern part of the KwaZulu-Natal Province. However by the end of the year 2000, the northern Kwa Zulu-Natal cholera outbreak had replicated itself in eight of South Africas nine provinces.

The main aim of this health systems research was to assess and improve the quality of TB smear microscopy results in a systematic way in the NP, as both false positive or negative results have serious implications. This research was also initiated to pilot the logistics of the proposed proficiency testing initiative for SADC countries (including SA) on behalf of the SATCI Laboratory Task Team (in consultation with the NTCP) in order to identify operational problems and solve them. The Northern Province was chosen as the operational realities approximate that of other SADC countries.

This report outlines an effort to address the management of Multi-Drug Resistant (MDR) TB in South Africa through the implementation of the DOTS Plus strategy. It is based on operational research, which was undertaken in the Lower Orange District of the Northern Cape Province between May 1999 and December 2000.