Globally, it is estimated that the Covid-19 pandemic has set back the fight against TB by between five and eight years and could result in an additional 6.3 million people developing TB and an additional 1.4 million deaths between 2020 and 2025. In South Africa, Health Minister Zweli Mkhize last week in Parliament said the department is committed “to find all persons living with active TB in communities”.
Mkhize said they noted “a 50% reduction in the number of TB tests conducted during the Covid-19 period”. He also said that the country had a sub-optimal TB treatment success rate of 78% - the target was 90%.
In response, various provinces have developed TB catch-up plans. The plan that appears to have made the biggest splash is that of the Western Cape, which has received strong backing from the province’s Premier and which has been described online in more detail than what we could find for plans in other provinces. (Spotlight will also write about TB catch-up plans in other provinces, should provinces share sufficient information.)
Adapting lessons from Covid-19
Speaking ahead of the launch of the province’s “multi-sectoral emergency TB plan” last month, Western Cape Premier, Alan Winde said the province took lessons from its fight against Covid-19 and adapted them for the province’s TB response plan.
“We believe that through this plan, we can prevent TB infection, link TB positive patients to treatment more quickly and ultimately save lives, as well as grow our economy,” he said.
One element of the province’s Covid-19 response has been its very useful Covid-19 dashboard. The dashboard shows information like the number of cases, deaths, and people who have recovered, all broken down by district and sub-district. We have not been able to find publicly accessible Covid-19 dashboards for other provinces that have similar functionality.
Now, the province wants to do something similar for tuberculosis.
Details of the dashboard
The TB dashboard is being developed by the Western Cape Department of Health’s provincial Health Data Centre. The province, and its data centre, already has a reputation for developing high-quality data systems in-house.
The dashboard will show TB diagnoses from the National Institute of Communicable Diseases (NICD), TB deaths, treatment successes, treatment initiation, and TB preventative therapy (TPT) initiations - all at the sub-district level.
Once launched in late June the dashboard will be updated with new data on a weekly basis.
According to Byron La Hoe, provincial health spokesperson, the aim of the dashboard is to follow the transparency model of Covid-19 and put TB numbers in real-time (as far as possible) in the public domain to create greater public awareness of the extent and impact of the TB epidemic.
“It is envisaged that the dashboard will help to create increased awareness of the TB epidemic in the Western Cape to encourage residents to identify signs and symptoms early, present to a health facility for TB testing, encourage those diagnosed with TB to successfully complete treatment (with the support of the community) and reduce TB-related stigma,” says La Hoe.
Broader TB catch-up plans
The TB dashboard is only one part of the province's TB plans. According to Winde, the province has a four-step programme of action. These four steps are (1) Raise awareness of TB and its harms to our society, (2) Prevent new TB infections, (3) Rapidly diagnose TB, commence early initiation of treatment and adherence up to treatment completion, and (4) Mobilise a whole government and whole of society approach to tackle TB.
The new TB awareness push will, among others, aim to destigmatise TB. According to the province, the awareness plan will not only be aimed at reducing stigma and raising awareness around TB but is also aimed at preventing new TB infections, diagnosing and getting people on treatment quicker, and ensuring those who start treatment, complete their treatment.
Spotlight previously reported on the increased use of mobile X-ray technology and other strategies used to diagnose more people with TB more quickly. The Western Cape’s new plans include the expanded use of X-rays, although it seems mainly for use in pilot programmes for now. The use of self-screening apps is also being tested.
La Hoe says the tracking of TB patients and improvement of TB screening rates have been institutionalised in all facilities in the province. Those who go for Covid-19 screening and testing can at the same time get TB screening and testing.
He adds that they have strengthened the social mobilisation strategies of finding TB in the community in collaboration with the supporting partners which can be civil society or non-profit organisations as well as inter-faith organisations. They will also be increasing TB testing at shelters.
The emergency plan also focuses on increasing the uptake of TB prevention therapy at healthcare facilities. This will be done by keeping better track of the uptake of prevention therapy and expanding the definition of Chronic Medical Conditions to include TB treatment and preventive therapy - which will presumably allow for TB prevention medicines to be distributed through the government’s CCMDD medicines distribution system.
There are also plans to provide new TB prevention treatments like 3HP (rifapentine and isoniazid) and 3RH (rifampicin and isoniazid) that cut the treatment time down from six months or more to only three.
The emergency plan also sets out to improve and maintain infection control at healthcare facilities and other places of congregation. As in other areas, however, it is unclear to what extent efforts here will go beyond what is already being done.
TB and HIV Care communications manager, Alison Best says the purpose of the plan is to ensure the same level of attention energy, and political will is devoted to TB as has been galvanized for Covid-19. “We certainly need a plan that can do that given the negative effect that the Covid-19 pandemic has had on TB services,” she says.
Co-Chair of the Premier’s Council on AIDS and TB (PCAT) who is also the chairperson of the Treatment Action Campaign (TAC) in the Western Cape Vuyani Macotha said, “I’m excited by the gaps we’ve identified. This is not just a document sitting in the Premier’s office but a tool to be shared with NGOs and the government. We have used the same approach to address Covid.”
Speaking at the launch of the emergency plan, Macotha said he was really happy with the plan and they welcome it. “Without leaving other illnesses outside, there is hepatitis which is also a major killer in the province that needs attention as well. A plan itself should expand to that particular area. As the civil society, we are very much excited to be part of this particular plan which is going to yield good end results.”
The plan was developed jointly by the government and civil society organisations. Macotha said that he hopes the working relationship between business, civil society organisations, and government that led to the plan will be cemented and carried on to other illnesses.
Note: A representative from the TAC is quoted in this article. Spotlight is published by SECTION27 and the TAC, but is editorially independent - an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
*This article was produced by Spotlight - health journalism in the public interest.