TB, HIV Target Out of Reach, says Study. 14/12/10

South Africa remains below target on reaching the Millennium Development Goal pertaining to tuberculosis and HIV-Aids

South Africa remains below target on reaching the Millennium Development Goal pertaining to tuberculosis and HIV-Aids, the 2010 South African Health Review says.

MDG 6 has as a target detecting at least 70 percent of new sputum smear-positive TB cases and curing at least 85 percent of these cases plus to reduce TB prevalence and death rates by 50 percent relative to 1990 levels.

The authors of the SAHR review chapter on HIV-Aids and TB pointed out that mortality due to TB and treatment interruption remained high in South Africa.

They attributed this to the high HIV infection rates and weak "health care service delivery mechanisms".

Before the emergence of HIV, the Western Cape reported the highest rates of TB. However, in 2006 KwaZulu-Natal, with an antenatal HIV prevalence of 39,1percent, exceeded the national HIV incidence rate, reporting a TB prevalence rate of 1066 in a 100000 population. The province also had among the worst National TB Programme performance indicators.

The SAHR confirms that the challenges faced are substantial and include increasing caseloads in the face of over-burdened health infrastructure, extremely poor cure rates in some provinces, high mortality, high treatment interruption rates, high levels of TB-HIV co-infection, increased levels of multi-drug resistant TB and the emergence of extensively drug resistant TB.

Of the high burden TB countries, South Africa has among the highest estimated costs for TB. This is due mainly to two reasons: the enormous cost of maintaining about 8000 TB beds and the cost of diagnosing and treating drug resistant TB.

Other challenges facing South Africa's ability to meet the MDGs are high treatment interruption rates, late presentation of patients to health facilities, insufficient community engagement, the HIV epidemic and poverty.

The SAHR revealed that of the 2472 and 2572 cases of MDR-TB diagnosed in KwaZulu-Natal laboratories in 2005 and 2006, respectively, only 56percent in 2005 and 28percent in 2006 were treated in hospital. The remaining patients died while awaiting admission, were lost to follow-up or remained infectious in the community.

The former health department director-general Thami Mseleku defended the institutional model for years though it was not reaching the majority of those with drug resistant TB.

Under Health Minister Aaron Motsoaledi there has been a definite move towards decentralising the management of MDR-TB.