South Africa has the highest estimated tuberculosis (TB) incidence rate amongst the 22 high burden countries globally, with 834 new TB cases per 100,000 population. But there is evidence that the rate of new confirmed TB cases in the country is dropping. Now an online TB Surveillance Dashboard has been developed to better track and analyse the infectious disease.
TB can affect people of all age groups but is most common among adults, particularly those co-infected with the human immunodeficiency virus (HIV). It is also the leading cause of death due to infectious diseases in South Africa.
The World Health Organisation (WHO) has launched a new strategy aiming to end TB by 2035 and has set ambitious targets for this to be achieved, requiring a 10% year-on-year reduction in TB incidence rates.
In 2015, the National Institute for Communicable Diseases (NICD) and the National Department of Health published findings showing evidence of a decline in the incidence rate of new laboratory confirmed TB cases in South Africa and the important role of the ART programme.
However, data was only presented up to 2012 and a further update was required. Additionally, due to the magnitude and variability of the epidemic across the country a more detailed analysis of the data to sub-district level was deemed important.
This led to the development of the real-time, online TB Surveillance Dashboard.
The dashboard provides a quick and easy way to visualise and track trends in TB incidence and identify geographic hotspots. Furthermore, it will support the new National HIV, TB and STI Strategic Plan (2017-2021) which emphasises the need for a data driven and targeted approach to end TB. The dashboard is available from the NICD website: www.nicd.ac.za.
An accompanying report based on the data available on the dashboard has also been produced. It provides an in-depth interpretation and contextualization of the findings.
The latest findings provide reason for optimism, with the year-on-year decline in TB incidence in South Africa since 2012, of 4.1%, 6.0% and 4.8% nationally for the years 2013, 2014 and 2015, respectively. Although this represents only half of what is required, it exceeds the global average year-on-year reduction of 1% to 2%.
Notably, in South Africa, KwaZulu-Natal, which carries the highest absolute burden in the country, has shown the greatest reduction over the three-year period, with a year-on-year reduction averaging 10.5%. Similarly, there has been an acceleration of the year-on-year reduction in the Free State from 2.5% in 2013, to 4.8% in 2014 and approaching 9.2% in 2015.
Although the broader roll out of antiretroviral therapy (ART) has been shown to be an important contributor in reducing TB incidence; this alone will not be enough.
A striking clue to the success and failure of the achieved reduction in incidence was observed when disaggregating by gender.
Most of the declines observed across provinces and reflected nationally, have been driven by successes achieved among females between 25-44 years of age with a 33.6% reduction between 2008 and 2015. These statistics link closely with the large emphasis of the HIV programme, as well as greater health-seeking behaviour among this population group.
In stark contrast, the reduction among males in the same age category was only 13.4% for the same period. Specific strategies aimed at this population group are urgently required if South Africa is to reach its End TB goals, including targeted public messaging, increased access through men’s health and wellness centres, and male role models. Breaking through this barrier will be challenging, but is likely to realise even greater reductions than in the past.
The observation of over 3m new cases of laboratory confirmed TB over the reporting period (2004-2015) highlights the magnitude of the TB burden.
Much like HIV, the disease is of a chronic nature, with new cases accumulating over time. However, unlike HIV, TB is curable and the majority of the aforementioned 3m TB cases have been cured – a statistic often underappreciated. This highlights the significant and direct value achieved by dealing with the TB epidemic effectively.
The current report provides valuable insights that should be closely integrated into TB control planning for the next five years. The report ends in 2015, however the online TB Surveillance Dashboard takes this further allowing ongoing monitoring of the status of this priority disease in South Africa.