Compassionate and comprehensive: How SA is approaching TBHealth Minister Dr Joe Phaahla delivers the keynote address at the national World TB Day commemoration at Evaton in Gauteng. (Photo: GCIS)

Compassionate and comprehensive: How SA is approaching TB

Comment & Analysis

South Africa is at the forefront of TB control efforts, striving towards improved health outcomes, argues Dr Priashni Subrayen.

South Africa has made significant progress in the fight against tuberculosis (TB), especially among HIV co-infected TB patients. There has been a 65% decline in TB incidence in South Africa between 2007 and 2021. During the same period, the country recorded an 80% decline in TB mortality among people living with HIV.

Despite these momentous gains, TB remains a significant health challenge in South Africa, requiring a strategic and comprehensive approach to combat its impact on individuals and communities.

The South African government has outlined key priorities for implementation of the SA TB Recovery plan, which operationalises the country’s National Tuberculosis Programme (NTP) Strategic Plan. Central to these plans are progressive interventions, including newer diagnostics, shorter, more potent treatment regimens, novel technologies such as digital chest x-rays to increase access to TB screening, and strengthening public private partnerships.

Underpinning all these new armaments we have in our TB arsenal, is person-centred and family-centred care, with support from our patients, their families and the community – which is crucial to achieving our TB goals. The NTP Strategic Plan provides a framework for strengthening TB prevention, detection and treatment, whilst increasing access to TB services, enhancing surveillance and monitoring systems, and expanding community engagement activities.

Diagnostics, tests and treatments

South Africa is embracing innovative interventions to enhance TB control efforts. Newer diagnostics allow for the rapid detection of drug resistance to a large number of antibiotics and new tests allow for a larger array of tests to be used in the country for TB detection. Furthermore, it is anticipated that diagnosing TB in children will become easier with the introduction of molecular testing of stool – since kids struggle to cough up sputum and TB detection is a bit more difficult, traditional sputum-based testing often doesn’t work.

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Shorter and more potent treatment regimens are reducing the burden of long-term medication on patients, leading to improved patient adherence and better treatment success rates. The 6-month regimen of bedaquiline, pretomanid, and linezolid (BPAL) for drug-resistant tuberculosis (DR-TB) is a novel treatment. Compared to older regiments to treat DR-TB, BPAL offers several advantages, including improved treatment outcomes, shorter duration, reduced toxicity, outpatient treatment, and reduced pill burden.

Similarly, compared to the traditional 12 months of daily TB prevention treatment for adults, the shorter course 3HP regimen – a combination of the two antibiotics isoniazid and rifapentine which is given weekly over 3 months – offers improved adherence, shorter duration, reduced risk of drug resistance, increased convenience, and potential cost savings. These advantages make it an important option for TB prevention efforts.

Artificial intelligence and the NHI

The integration of artificial intelligence in TB programmes is enhancing data analysis, treatment optimisation, and resource allocation, allowing for more efficient and targeted interventions. In South Africa, we have currently expanded the use of digital chest x-rays with computer assisted detection, which allows for improved TB case finding in communities. These innovations are revolutionising TB management in the country and paving the way for more effective control strategies.

As South Africa aims to transition towards universal health coverage (the National Health Insurance Bill, which seeks to realise universal health coverage, has been sent to President Cyril Ramaphosa for assent), public-private partnerships are becoming increasingly crucial in expanding access to TB services and optimising resource utilisation.

Leveraging the strengths of both sectors, these partnerships can improve service delivery, increase funding opportunities, and enhance the quality of care for TB patients. By working collaboratively, the government, private sector, and civil society can address the multifaceted challenges of TB control more effectively and sustainably, ultimately advancing progress towards universal health coverage.

Tuberculosis is caused by bacteria and spreads through air and can infect anyone. (Infographic: World Health Organization)

Better healthcare outcomes

Patient-centred and family-centred care offer several advantages that contribute to better healthcare outcomes and improved overall satisfaction for patients and their families.

Fundamental to this approach, is open communication between healthcare providers, patients, and their families. By actively involving patients and their families in care decisions, healthcare providers can tailor treatment plans to better meet the patient’s specific needs and circumstances.

This approach also empowers patients to take an active role in their healthcare decisions. By providing information, support, and encouragement, healthcare providers help patients and their families feel more confident and capable of managing their health.

The investment in time with keeping the patient engaged and empowered allows health care workers to focus more on health and care and less on policing patients which, given our limited resources, is vital.  This personalised approach often leads to better adherence and improved health outcomes and reduced healthcare disparities.

This approach prioritises advancing the country’s TB programme’s integration into community-based care and include the following concrete steps the National TB plan is taking, to improve patient-centred care:

  • Advocacy for tuberculosis across various sectors and delivering targeted messaging.
  • Ensuring test results are accessible beyond healthcare facilities (for example through mobile phone notifications)
  • Enhancing referral systems and establishing robust connections between care centers.
  • Providing safe, high-quality treatment with increased convenience.
  • Offering treatment alongside psychosocial support tailored to vulnerable individuals and communities.

By prioritising patient-centred care, the South African government is working towards a more compassionate and comprehensive approach to TB management. By embracing innovative interventions and fostering public-private partnerships, South Africa is at the forefront of TB control efforts, striving towards improved health outcomes. Through a holistic and collaborative approach, the country is making significant strides in combating TB and promoting the well-being of its population.

*Subrayen is Technical Director for TB at the Aurum Institute and Chief of Party of ACCELERATE 1, a new flagship TB programme to support government’s TB response. She also heads the Secretariat of the South African National TB Think Tank.

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