Antiretrovirals credited for TB decline

South Africa is seeing about 79,000 fewer TB cases annually thanks to increased HIV treatment uptake, according to the latest research from the National Institute for Communicable Diseases (NCID)

Ismail's data shows that sharp rises in ARV uptake were followed three years later by sharp decreases in TB incidence.

Ismail’s data shows that sharp rises in ARV uptake were followed three years later by sharp decreases in TB incidence.

South Africa is seeing about 18 percent fewer new TB cases annually due to the increasing numbers of people living with HIV who are on antiretrovirals (ARVs), according to research presented yesterday at the South African TB Conference by NCID ‘s head of TB Dr Nazir Ismail.

The drop comes after year-on-year increases of TB cases peaked in 2008, a marker of what Ismail called a huge burden of the disease that had spun out of control.

However, from 2009 TB cases began decline and by two years later,  South Africa was charting a steady annual drop in lab-confirmed cases, which continues according to 2013 data, Ismail added.

Meanwhile, the number of people tested for TB has risen by 300 percent since 2004 owing in part to integrated HIV and TB testing conduced as part of the national HIV counselling and testing (HCT) campaign.

Increased testing rates give Ismail confidence his figures are not a fluke.

“We’ve observed massive jumps in TB testing and millions were tested through the HCT campaign,” he told Health-e News. ”I don’t think the trend is due to a lack of testing therefore the trend is real.”

With HIV prevalence rates largely stable, Ismail also said he doubts dropping TB cases are due to a decrease of South Africa’s HIV burden. About 60 percent of South African TB patients are co-infected with HIV, which can increase a person’s risk of developing active TB by more than 30-fold.

He credited Health Minister Dr Aaron Motsoaledi for driving the ARV scale-up that he said was saving the lives of TB patients, most of whom were in the most economically productive years of their lives.

According to Ismail’s data, each sharp increase in ARV uptake nationally was followed by a sharp decrease in new TB cases about three years later.

TB accounts for about ten percent of all deaths in South Africa but declines in new cases have helped the country raise life expectancy, he added.

Unequal benefits in an unequal country

The Central Karoo region and KZN’s eThekwini Municipality have seen increases in TB incidence

However, he cautioned that not all areas of the country were reaping the benefits. While the Northern and Western Capes have charted early declines in TB cases, some provinces like KwaZulu-Natal are just starting to see these numbers fall. Worse yet, some parts of the country like the Central Karoo region and KwaZulu-Natal’s eThekwini Municipality have actually seen a rise in TB cases.

Ismail is also leading the country’s first study into rates of drug-resistant TB in 15 years. The study is the largest such study ever conducted in the world.

Without proper attention, drug-resistant TB will be South Africa’s next major epidemic, Ismail said.

The World Health Organisation’s (WHO) Dr Christopher Dye cautions that despite these gains, many TB cases never make it to the lab.

Only about 60 percent of TB cases are ever detected in South Africa and of these, only half are cured, said Dye who is the WHO’s director of health information for HIV, TB, malaria and neglected diseases.

“We clearly need to push these rates up in order to push the TB epidemic down,” said Dye.

South Africa will also not meet targets laid out in its National Strategic Plan on HIV, TB and Sexually-Transmitted Infections (STIs) to halve TB deaths between 2010 and 2016, according to Dye.

He added that the target was overly ambitious because it would have meant a ten percent reduction in new cases annually. – Health-e News Service.

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