This 'terrible twin' is killing more South Africans

Tuberculosis is HIV's 'terrible twin'.
Tuberculosis is HIV's 'terrible twin'.

Death rates have declined, largely due to successes in HIV, but a lot more needs to be done to defeat its “terrible twin”, tuberculosis (TB).

This is according to the 20th edition of the South African Health Review published by the Health Systems Trust (HST) on Wednesday.

A great success story

The review, published annually, noted that life expectancy which rose from its lowest levels in the mid 2000s, has been maintained. In 2006, due to the explosion in new HIV infections and little access to treatment, life expectancy was 52 years but in 2015 it had risen to over 63 and remains stable. This increase was driven by a massively scaled-up antiretroviral programme: the largest in the world.

It noted that the prevention of mother-to-child transmission (PMTCT) of HIV, another big driver in helping people live longer, “is one of the success stories of the 21st century in South Africa”.

Before 2001 up to 30% of babies born to HIV positive mothers tested positive for the virus at six weeks of age. As of 2016 this has “plummeted” to around 1.4% supported by national policy, political will and scientific evidence.

There have also been successes in prevention. Since 2010, an estimated 10 million HIV tests and half a million medical male circumcisions are done every year, while 750 million male and over 25 million female condoms are distributed.

More needs to be done

Despite this, many gaps remain. Key populations, those at higher risk of HIV infection, “pose particular challenges in the South African context”, noted the review. These include sex workers, people who inject drugs, transgender people, prisoners and men who have sex with men.

According to the Joint United Programme on HIV/Aids more than 20% of new infections in sub-Saharan Africa were in key populations and more targeted interventions are needed to reach these communities who are often stigmatised and struggle to access services at traditional health facilities.

The review also noted that more needs to be done to address drug-resistant TB (DR-TB) as it is “a significant threat to end TB efforts in South Africa”. It has implications for the fight against HIV as up to as many as 60% of TB patients are co-infected with HIV.

Although just under 20 000 patients were diagnosed with DR-TB in South Africa, in 2015 the numbers continue to rise and there are concerns that a significant number of cases are undiagnosed.

A black cloud

While the country has recently expanded access to newer drugs for DR-TB the review noted that there are variations in available DR-TB services across different provinces. For example the national policy of decentralising DR-TB services, out of hospitals and into communities, has not been implemented evenly across provinces.

“HIV has been a black cloud dominating the health landscape over the past 25 years,” note Professor Peter Barron and Ashnie Padarath in the review’s editorial.

They said that the most important success in reflect on is the response to HIV which has been “instrumental in improving the key health indicators relating to death rates, life expectancy, and maternal, child and infant mortality”.

“Nonetheless, it is also very clear that challenges remain and that much needs to be done to improve governance, leadership and accountability at strategic, district and facility level, as well as in terms of the overall planning and implementation of the health workforce.” – Health-e News.

Image credit: iStock

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