A high level World Health Organisation (WHO) delegation has given South Africa’s tuberculosis (TB) programme cautious thumbs up pointing out that the critical integration of TB and HIV services were not satisfactory and that infection control at health facilities was lacking.
South Africa currently has the highest number of patients co-infected with TB and HIV in the world.
The WHO Stop TB delegation last week handed over the findings of a joint review to Deputy President Kgalema Motlanthe and health minister Dr Aaron Motsoaledi.
Irene Koek, chair of the WHO’s Stop TB Partnership Board, said after the meeting on Friday that the review had found ‘real improvements’ in all provinces except KwaZulu-Natal and the Northern Cape.
‘The case finding and treatment rates are up, with tremendous improvements in the laboratory services ‘ seeing remarkable turnaround times in the delivery of results ‘ and no issues with drug supplies or stock outs,’ said Koek.
She admitted that South Africa still had a ‘long way to go’ in tackling the drug resistant TB epidemic, but said the review had identified very good treatment models which they hoped could be replicated.
Koek said the biggest area of concern in South Africa remained the dual epidemic of HIV and TB with unacceptably high mortality rates. She said 90% of TB patients were being screened for HIV, but that the reverse was not happening to the degree that it should (HIV patients tested for TB) and that this could be ascribed to the fact that the TB and HIV services were not integrated. ‘It’s not easy to do (integration), but our sense is that the South African health department is serious about taking on the challenge,’ said Koek.
She added that there also needed to be a very specific focus on the TB services being offered at the mines and in prisons. ‘Not all mines are providing services and because of the issue of migrant workers we need to make sure that cross border connections are happening because it is not happening to the degree that it should. Prisons are also recording very high rates of TB,’ said Koek.
Although the TB review has not been made public a joint statement by the WHO and health department said South Africa’s management of TB had significantly improved compared to what it was in 2005.
Specifically, it said the TB defaulter rate had declined and cure rate had increased. However, TB experts have questioned whether South Africa’s cure rate was not an overestimate as there are indications that the prevalence rate was being underestimated.
According the statement the Joint TB Review looked at the Directly Observed Treatment Short-course Strategy (DOTS), TB/HIV co-infection, drug resistant TB and Public Private Partnerships and Advocacy, Communication and Social Mobilisation. The review included observations of provision of care in clinics and hospitals, interviews with TB services managers and health workers.
The Review found among others major improvements on quality and access to TB services (TB diagnosis and treatment available in all health facilities) resulting in increased case detection and treatment success.
Human Resources were found to be sufficient in some provinces but insufficient in others and very often not adequately trained in TB control.
The Review recommended that infection control measures be improved as this was found to be weak. It called for the management of TB/HIV co-infected patients at the same facilities with effective infection control measures. It said that infection control must be strengthened through the formation of national and provincial infection committees and by assigning this responsibility to dedicated focal persons.
The Review has also recommended that NGOs working on HIV should also work on TB.