Members of the Mayoral Committees for Health from all Gauteng,
Local Councillors present,
Ladies and gentlemen.
South Africa is one of the 22 countries with the highest burden of TB. In fact we are part of the countries that account for 80% of all TB cases in the world. The rate of TB infection has almost doubled in Gauteng since 1996.
This increase in the rate of TB infections is alarming when one considers that out of 100 000 people in 1996, 195 were infected with TB, and this rate of infection had sky rocketed to 444 per 100,000 in 2006 in Gauteng
While this challenge is not unique to Gauteng alone, it is a worrying factor when one takes into consideration the resources that we have dedicated to the fight against TB.
Gauteng province covers just over 17 000sq km - approximately 1.4% of the total and surface of South Africa. It is the smallest province in terms of size, but the densely populated of all the nine provinces.
This dense population is evident in over-crowding and increase in living conditions that are not conducive to a healthy population. These living conditions are some of the factors which contribute to the increased rate of TB infection in our province
Programme Director,
Countries which do not have the resources that are at our disposal fare better than Gauteng in their efforts to fight TB. We therefore have to review our strategies in order to improve our outcomes. I know some will argue that the increase in the number of people who have been diagnosed with TB is due to improved case finding. However, it should continue to worry us that more people are becoming infected in the first place.
This year we have budgeted over R230 million to fight the scourge of TB. Therefore, outcomes should reflect the resources that we have ploughed.
It is generally known that TB is successfully treated in six months when one takes his or her medication without fail. However, when a patient defaults on treatment, he or she runs the risk of contracting multi-drug resistant TB. To treat ordinary TB costs between Four Hundred Rand and Seven Hundred Rand only, however to treat multi-drug resistant TB costs between Twenty Four Thousand Rand and Thirty Thousand Rand per patient including hospitalization if a patient is still infectious.
At the end of 2006, South Africa was engulfed by XDR, which is a highly resistant strain of TB. A number of lives were lost, and we cannot afford to go through a similar experience, as it puts a strain on our health system.
Since the launch of the HIV Counselling and Testing campaign in 2010, 75% of those who tested positive for HIV were also co-infected with TB. That is why we have intensified our measures to ensure that we increase knowledge on recognizing the dangers of TB in all its forms namely drug sensitive TB, MDR and XDR-TB as well as the relationship between TB and HIV, and availability of health and other related services. That is why we have incorporated TB screening in our HIV and Counselling and Testing campaign.
We even trace and screen family members of those who have been diagnosed with TB. If a person tests HIV positive and shows no signs of TB we provide them with INH prophylaxis which prevents contracting TB.
Programme Director,
Our interventions should not be limited to treating those who have already been diagnosed with TB. Prevention is also crucial. That is why we emphasise community mobilisation. When communities are aware about causes of TB, about TB symptoms, and provide support to those who are on treatment, we will have gone a long way towards winning the battle against TB. This also involves family members supporting those who are on treatment. If family members are stigmatised, it becomes difficult for them to adhere to treatment regimens.
TB is curable and we need to re-emphasise this message.
Even if one is HIV positive, TB is still curable as long as one takes treatment as prescribed by health care workers. In order to address the situation highlighted above the following issues have to be embarked on:
- heightening public awareness on the dangers of TB
- educating our people on the signs and symptoms of TB
- emphasising the importance of completing the TB treatment and consequences of failure to do so.
Drugs alone will not win us the war we are faced with. We have to re-consider the tactics that we have employed in the past in the fight against TB. We need to strengthen community awareness because there is evidence that our people are not presenting themselves to be tested for TB earlier when they begin to show symptoms. The fact that some of our people only come for treatment when their condition has worsened means that the burden of TB will continue increasing.
Programme Director,
I said earlier that Gauteng is the smallest of all provinces in terms of size, therefore our messages should reach our people faster, and we no longer have a serious problem of access to basic health services.
Therefore our clinics are available to test TB and treat TB. In addition, we need to ensure that we empower our people to use the information that is at their disposal responsibly.
We need re-examine our communication strategies in order to ensure that the messages we convey impact on behaviour. We need to reduce the stigma that is associated with TB. Community Based Organisations, faith based organizations and community leaders have a role in this regard.
Programme Director,
In 2012, in the whole of Sedibeng, 72,085 people were tested for HIV. Out of these, 12,247 tested HIV positive (16%). There were 12,489 HIV positive patients screened for TB. Out of these, 1201 were confirmed with TB. There were 5,320 TB cases diagnosed in 2012. Furthermore, 69% of TB patients in Sedibeng were HIV positive.
Out of these, 63% of those eligible received Anti-Retro Viral treatment. While the cure rate has improved drastically from 70% to 81% in the past 3 years, it is still a matter of concern that the defaulter and death rates are higher in Sedibeng when compared to other districts. The defaulter rate in 2012 was 7% in Sedibeng, compared to 5% in the whole province.
This is attributed to late diagnosis of patients with HIV. There is therefore a need for intensified HCT campaigns and TB screening.
This emerging epidemic of multi and extremely drug resistant TB is of particular concern as it poses a threat to both TB and HIV programmes provincially and nationally. It even impacts negatively on TB control in the SADC region due lack of continuity of care when patient with drug resist TB return home to neighbouring countries.
We can still do more to improve the over- all cure rate by strengthening the over- all reporting systems. But these need collaboration with communities themselves to ensure that they adhere to treatment regimens, and report their internal migration in order to reduce the rate of treatment interruption.
Sometimes we give bureaucratic responses such as under reporting when we are asked to account for lower over- all cure rates, but forget that deaths resulting from interrupted treatment, Multi-Drug Resistant strains, and late detection of TB cases bear no relation to these bureaucratic answers.
Human life is at stake here, and it is largely those who are supposed to be economically active who are infected with TB.
Programme Director,
I have been reliably informed that in 2011 there were 56 000 TB cases which were diagnosed in Gauteng and only 706 had Multi-Drug Resistant TB. The co-infection rate with HIV is 75%, indicating the need to combine efforts in fighting the two epidemics. There were only 5 300 TB-related deaths, constituting only 6%.
Surely this means a lot of work lies ahead of us. The fact that the TB budget for 2013/14 financial year is a whopping R286 272 000, an increase from R239 851 000, in 2012/13 financial year means that TB outcomes must also reflect this allocation!
