South Africa, one of 30 countries in the world with a high TB burden, wants to intensify the fight against tuberculosis (TB) by increasing the number of people testing for the disease to five million over the next twelve months. This would be a significant increase from the 2.7 million tested in 2023. 

Speaking at the launch of the programme on Wednesday, head of the country’s TB programme Professor Norbert Ndjeka, says scaling up testing will help South Africa reach the target set in the World Health Organisation’s (WHO) strategy to end the global TB epidemic by 2035. 

“Modelling suggests testing five million people annually will help achieve a 29% reduction in TB incidence and a 41% reduction in mortality by 2035,” he says. 

Where are the gaps? 

The WHO targets are: 

• 95% reduction by 2035 in TB deaths 
• 90% reduction by 2035 in new TB cases
• Zero families facing catastrophic costs due to TB

Since the start of the End TB strategy in 2015, South Africa has seen a 53% reduction in new TB cases, surpassing the WHO 2025 target of 50%. In the same period, it increased treatment coverage from 58% to 77%, but failed massively to reduce deaths. The WHO target is 75%, but TB deaths only went down by 16% over the same period.  

In 2023, TB claimed 56 000 lives, making it one of the leading causes of death in the country.  

“This means one in five people die from TB in South Africa every year,” says Ndjeka. 

Obstacles to TB response

South Africa’s fight against TB is faced with social and economic challenges. 

“One of the key obstacles is the persistent stigma surrounding TB and HIV which often deters individuals from seeking timely diagnosis and treatment. The co-epidemic of TB and HIV complicates treatment as many patients face difficulties in managing both diseases simultaneously,” Ndjeka says. 

Other barriers to effective TB care include a lack of trained healthcare workers, poor referral systems, drug stock-outs and mistrust in the health system.

Ndjeka adds that limited access to healthcare services in rural and remote areas, coupled with inadequate infrastructure and resources hinders early detection and proper care. 

Health Minister Dr Aaron Motsoaledi says catastrophic costs highlight the significant financial strain faced by TB-affected households. 

A South African TB patient cost survey reveals that 56% of TB patients experience catastrophic costs.

“This is one of the reasons why we lose many people in treatment,” says Motsoaledi. 

Spread of TB

Professor Nazir Ismail from the WHO’s global TB programme says that 58,000 people with TB are undiagnosed and untreated, a slight decline from 66,000 in 2022. He says these cases contribute to the ongoing transmission of TB. “For every diagnosed case of TB there is another person who is missing,” he says.

Males contribute a larger proportion of TB cases but are less likely to access treatment.

“More people who test positive for TB are asymptomatic (showing no symptoms). This is another significant issue, as 68% of transmission occurs from asymptomatic TB. Sick individuals will seek care, but those without symptoms remain in the community for much longer and transmit TB to others,” he says.

Key strategies to end TB

Ndjeka says key strategies include accelerating targeted universal TB Testing a strategy used to improve TB diagnosis by screening people at high risk for TB, to reach people living with HIV and household contacts of confirmed TB cases, conducting community-wide screening and forming public-private partnerships to increase access to TB testing through general practitioners. 

He says fighting TB requires multi-sectoral engagement and closer collaboration with communities to address demand and supply side factors and to find and successfully treat people with TB. 

‘With increased case finding we need to continue to strengthen linkage to care and retention in care,” he says.  –Health-e News