Western Cape strengthens efforts to improve TB control in the province

Through its multi-sectoral response plan to reduce the spread of Tuberculosis (TB), the Western Cape is making progress to prevent TB infection, link TB positive patients to treatment quicker and save lives. TB is completely curable, even drug-resistant TB, if it is diagnosed early and the person is adequately supported to complete their treatment. 

To address the multiple drivers of TB, the response plan was initiated in April 2021 through collaboration between civil society and the Western Cape Department of Health and Wellness. The plan is further supported by existing plans, such as the Western Cape’s Implementation Plan for the National Strategic Plan on HIV, Sexually Transmitted Infections (STIs) and TB, which is currently under review. 

"As we observe World TB Day today, it is important that we acknowledge the impact TB has had on our communities and the lives lost as a result. Despite this, I am proud of the department's proactive response which is saving lives daily. Our approach is centred around bringing in all of society and government together. This bolsters our current TB interventions, so that the true effectiveness of our services can be achieved,” said Dr Nomafrench Mbombo, Western Cape Minister of Health and Wellness.  

“We cannot do this alone as we need every resident to assist us on this journey. If you or any of your loved ones are displaying any symptoms, we encourage you to get tested, and remain on the prescribed treatment should you be positive. TB is an easily curable disease when identified and treated effectively. As a department, we are here to provide quality services FOR YOU," added Minister Mbombo. 

“It is a high priority for the Western Cape to address the TB epidemic. Our recovery efforts have been driven by a collaborative whole-of-society approach, leveraging the collective ownership of the response plan, by adopting the view of ‘health is everyone’s business’. It is noted that we are showing an upward trend in indicators as services have returned to normal post COVID-19 pandemic. In this current financial year (2022/23), we have seen an increase in numbers of persons tested at 293 477, and a decrease in the TB positivity rate at 14,9%, with efforts to reach key and vulnerable populations using data, innovation and technology,” said Dr Keith Cloete, Head of Department, Western Cape Department of Health and Wellness.   

Our key indicators show us that to date:   

• The percentage of all patients who tested positive for TB were started on TB treatment is 78%; 
• The TB treatment success rate is currently 73%;  
• The rate of successfully treating patients with multidrug-resistant TB is 50%; 
• The TB death rate is 5% for drug-sensitive TB (DS TB) and 14% for drug-resistant TB (DR TB); 
• Our TB screening rate for the 5 years and older presenting with symptoms is 86%; 
• Our TB screening rate for the children below 5 years presenting with symptoms is 87%; and 
• The rate of TB patients lost to follow up is 21%. 

Progress on TB response plan  

The first step in the plan is continuous raising of awareness of TB as the leading cause of death in South Africa for more than a decade. As part of this we are encouraging more people to know and see the signs in themselves and others, and to react accordingly. 

We have developed a public facing dashboard www.westerncape.gov.za/site-page/provincial-tb-dashboard which includes a self-screening tool which has been used 3 179 times during the 2022/2023 financial year to date. Approximately half of the users screened positive, and 73 self-reported TB tests were done, of which 15 came back with positive results. This highlights the high number of self-screening post COVID-19 pandemic, especially in the Khayelitsha/ Eastern district and Drakenstein subdistrict, driven by increased advocacy, communication, and social mobilisation. 

The second step is the ongoing prevention of new TB infections and improved case detection. Several initiatives have already been incorporated into our fight against TB: 

• Since August 2022, the National Health Laboratory Service (NHLS) has implemented SMS communication of TB test results to clients, enabling them to receive their results within 72 hours and prompting them to return to their clinics to start treatment if they test positive 
• Since December 2022, we have been using the Western Cape Government Contact Centre  to contact clients who test positive for TB within two weeks to ensure that they are clinically well and to ensure that they return to their clinics to start treatment.  . To date calls have been made to 1 173 TB clients called. Of those that were reached, 83% have been successfully linked to care.  
• We are successfully implementing TB Prevention Treatment for HIV positive clients, who are very susceptible to TB. To date (Q1-Q3 2022), 22 533 people have been screened, of which 52,7% were found to be eligible with 69,5% started on TPT and  75,9% have successfully completed TPT.  
• Since December 2022, we  have implemented a new shorter TB preventive therapy (TPT) regimens called 3HP at selected sites. It is a 3-month course of treatment that is effective in preventing progression from TB infection to active TB.  
• Urine-LAM have also been introduced since December 2021 to improve TB diagnosis in HIV positive clients with low CD4 counts. A total of 23 555 tests were issued from December 2021 until the end of quarter 3 of 2022, Going forward, we plan to also implement Targeted Universal Testing for TB (TUTT). for people who are high risk of developing  TB. People who are HIV positive, have had previous TB and who have been in close contact with someone that has TB will receive a TB test, irrespective of TB symptoms. This will enable very early diagnosis and initiation of treatment, and will save many lives. 

Going forward, we plan to also implement Targeted Universal Testing for TB (TUTT) over three years (2023-2026) in communities through NPO support in seven high burden TB districts and subdistricts. TUTT will see everyone at high risk of TB receiving a TB test after they have been in close contact with a person diagnosed with TB or on TB treatment in the past year, irrespective of TB symptoms. 

Our third step is ensuring the rapid diagnosis of TB, early initiation of treatment and adherence up to treatment completion.  

Currently, three districts (Southern Western, Garden Route and Overberg) are implementing a community-based pilot project focusing on TB screening and TB contact tracing, as well as TB sputum collection at community level and linkage to the nearest healthcare facility. Various strategies are implemented to improve early case detection and linkage to care. For the period 1 October to 12 December 2022, the project has screened 6 323 clients, tested 1 844 clients with 73 clients testing positive and linking to care.  Without this intervention, these 73 clients may not have been found and initiated on TB treatment and contributed to the spread of TB infection in the community. 

Our fourth step is to mobilise a whole of government and a whole of society response to tackle TB. The department will continue to advocate for a multi-sector response through establishing, nurturing, and sustaining key partnerships with civil society and other government departments. One example of this is the integration of the District Councils on AIDS and TB into District Health Councils and the capacitation of clinic committees.  

Through these steps we aim to not only meet but exceed global and local commitments to end TB by 2035.  

As a department we are fully committed to working with our communities and partners in ending TB. If you think that you or one of your loved ones may have TB, you should immediately consult a healthcare practitioner, who can conduct a clinical assessment, send away sputum for testing and possibly refer you for further x-ray testing. You can also use the screening function available on the TB dashboard for additional guidance. If you had close exposure to TB, please also talk to your healthcare provider, who will screen and test you, and may offer you TB preventive therapy which includes antibiotics to prevent you from becoming ill with TB.

Video message by Premier Alan Winde: https://fb.watch/jtcftCPI2D/