Speech by Minister of Health, Dr. Joe Phaahla, at the TB Indaba, Southern Sun-Elangeni, Durdan, 20 June 2023
The Director-General for Health,
MECs for Health, and the Heads of Department in attendance,
Health Care Professionals;
Representatives of Partner’s organizations,
Members of the Civil Society, Fellow South Africans,
Distinguished guests, ladies, and gentlemen – All protocol observed.
It is a great pleasure to see us all gathered, in person and virtually, at this pre-meeting of the 11th SA AIDS Conference. I am privileged to be here today to reflect on South Africa’s TB epidemic and response as we strive to recover from the devastating effects of the COVID-19 pandemic. It is only through firm commitment and a shared resolve between all stakeholders in the TB community that we can hope to make meaningful strides, improve the experience of our TB clients, and achieve the goals of the End TB Strategy. I trust that our presence here shows our commitment to strengthening the National TB Programme, and the value we place on dialogue and consultation.
Impact of COVID-19
Over the past three and a half years, we have endured the most important public health crisis of our lifetimes. The pandemic has profoundly impacted on all of us, individuals, families, communities, economies, the country, and the world.
By the end of 2022, we had lost over one hundred and four thousand (104,000) lives to this pandemic in South Africa. We also know from the SA Medical Research Council surveillance of excess deaths, that the true number of deaths is likely to be two to three times higher.
Let us not forget the successes. South Africa served at the forefront of the global COVID-19 pandemic response, detecting new variants of concern, reporting early surveillance data to the world, and producing key research. The rapid development of effective COVID-19 vaccines and administering over 13 billion doses globally, was an unprecedented scientific achievement requiring massive investment and collaboration. Through global commitment and collective action, we have shown that success against communicable diseases threats is within reach despite our numerous social, economic, and political challenges.
TB Epidemic
South Africa is on the three global lists of high-burden countries for TB, HIV-associated TB, and drug resistant TB. The World Health Organization (WHO) estimates that over one hundred and ten thousand (110,000) people with TB in South Africa lost their lives between 2020 and 2021. Since 2010, over one million South Africans are estimated to have succumbed to TB which is preventable and curable.
The COVID-19 pandemic and associated lockdowns have severely impacted on TB services throughout the country. Between 2019 and 2020, the number of TB tests provided in South Africa decreased by 23% and case notifications decreased by 25%. There has been some recovery since 2022, but it is estimated that the pandemic has reversed 12 years of global progress against TB.
Immediate response: TB Recovery Plan
After extensive consultation with all stakeholders, we developed the TB Recovery Plan. The TB Recovery Plan is a target-driven, evidence-based plan aimed at finding people with undiagnosed TB, strengthening linkage of people diagnosed with TB to treatment, strengthening retention in TB care, and strengthening TB prevention.
South Africa is at the forefront of TB research and development. There are some new interventions and exciting developments. e.g., Expanded screening activities with TB Health Check, as well as the use of digital chest X-ray for TB screening. For the people with undiagnosed TB, we plan to screen 1 million people, 60% PLHIV tested and notification of 215 900 patients through annual TB tests. This will be augmented by 300 000 chest x-rays screening. We will also introduce TB results notification system to patients via SMS to improve linkage to treatment. We will soon be using new molecular diagnostic tests for TB.
We plan to put 85% of the lab diagnosed patients on treatment, and we wish to retain 86% of the Drug Susceptible TB on treatment through the strict and strengthen adherence to treatment programme. We are also planning an introduction of more patient-friendly treatment regimens (4-month paediatric drug-susceptible TB and 6-month drug-resistant TB regimen) to improve retention in care. A TB vaccine is advancing to a phase III trial in South Africa, with promising results.
We want to scale up implementation of new TB preventive therapy including 3HP (three months of weekly rifapentine and isoniazid oral treatment) to improve TB prevention and reduce transmission, especially among household contacts.
Progress we are making…
Through the implementation of the TB Recovery plan, we are starting to see improvements in TB testing, notification, and TB incidence. The number of GeneXpert tests done in 2019 was just over 2 million and decreased to 1.5 million due to COVID-19 in 2020. Since then, we have observed some recovery in TB testing, with 1.9 million tests done in 2021 and 2.5 million tests in 2022, which gives us signs that indeed this recovery plan will take us back where we were before the pandemic. In this regard, we are proud to report that the performance has been as follows: Between 2009 and 2021, the estimated TB incidence has decreased from 644,000 to 304,000.
TB notification increased from 187,735 in 2021 to 226,689 in 2022, and we exceeded our 2022 target of 215,900. These trends are consistent and robust and provide encouraging evidence that we are on track to meet global targets, because that is where we best compare ourselves with other countries in the world. We intend to move even faster and further to ensure that we fully recover losses suffered.
Based on 2021 estimates, we are on track to meet the WHO target for reduction in TB incidence rate in 2025 of 50%; and we are also likely to meet the 2030 SDG target of 80% reduction in TB incidence rate. We await the Tembisa modelling to provide the latest estimates of TB incidence. We recommit to continue to accelerate the decline of TB incidence, and to achieve this, we must double our effort in finding TB to end TB. That is why we are reprioritizing communication and advocacy to create demand for TB testing.
Opportunities to end TB
The HIV, TB and STIs NSP and the integration of TB and HIV services are opportunities we must improve our patient’s experience. Approximately 60 % of our TB patients are people living with HIV. This provides an opportunity for better patient’s outcomes.
We are pleased that the NHI bill has now proceeded to National Council of Provinces, where a vote will be taken today, after which we will enter an interesting phase of lives in health system management. NHI aspires to strong National Health System, buttressed by a viable District Health System that invests its resources in PHC services, clinics well run, embedded in the PHC system across the health system. A strong PHC system means strong TB and HIV services, strong health services closest to our people.
The recommendations of the TB Indaba will provide an opportunity to strengthen implementation of the TB recovery plan 2.0 in that kind of a system where PHC is the focus of our attention for the delivery of health services. These outcomes will be aligned with the recently launched National Strategic Plan for HIV, TB and STIs for 2023-2028. South Africa has a critical mass of world-renowned TB experts, clinicians and researchers, and very integrated multi-stakeholder community, which together form a formidable force, which when properly managed and coordinated, can achieve the results.
I therefore put it to you: How then shall we work together to get control of this TB epidemic? This is the question that this indaba must respond to if we are to gain foothold on the TB management system.
Strategic Directions we are taking
Through the National TB Recovery plan, we have moved swiftly to gather and implement evidence-based solutions to gain back the ground lost during the pandemic. Together we have also channeled our efforts to keep to our End TB promise by developing a clear strategic vision informed by the evidence – much of it generated locally.
Over the next 5 years, we will work toward a system that supports people from the moment they meet a health provider – public, private, or traditional – to know their test result and link to care within a week. We will work toward a system that provides better care, through shorter regimens and tailored support in facilities and communities. We will work toward a system that values prevention as much as treatment and supports both the users and the providers of the health services.
For us the adage of prevention is better than cure is as relevant today, as it was when it was first said. The mainstay of us ensuring that we end TB is to invest in the prevention of services to reverse the trends.
We will work towards better implementation of services and providing quality testing and treatment to people with TB, frontlines.ma and discrimination.
We will work with communities and their leaders to use their networks to convey messaging about TB.
And we will work towards creating a culture of data-driven decision-making, building public facing dashboards to ensure accountability and that funds can be leveraged and prioritized to areas and populations that need it most.
This vision was built through collaboration. With your support, we are committed to Ending TB by 2035.
Conclusion
The theme of the AIDS conference for this year is Act, Connect and End The Epidemic. We now need to take HIV and TB to the finish line: health care workers, donors and partners, scientific community, and civil society. This TB Indaba will provide a wonderful opportunity for participants to get involved in conversations, dialogues, and debates around some of the most pressing issues facing the National TB Programme.
Let us enjoy these proceedings, and may we remember to ensure that our engagement today leads to sustainable development with a positive impact on the TB response. We in the NDoH commit to making it easier to translate your recommendations to practice.
WE need to FIND TB TO END TB
Yes! You and I CAN END TB in our lifetime.
Thank you for your attention.
Source: Government of South Africa