Tuberculosis (TB) remains South Africa’s deadliest infectious disease, claiming 56,000 lives in 2023, despite new cases declining sharply in recent years.
“Over the years, we’ve been struggling with this. We still see a lot of patients continue to die from tuberculosis,” says Norbert Ndjeka, Chief Director: TB Control and Management in the National Department of Health. He was speaking at the Southern African HIV Clinicians Society (SAHCS) conference in Cape Town this week.
South Africa is among the 30 countries that have the highest TB burden in the world. In 2023, around 270 000 people had the disease. More than half of these cases (54%) were among people living with HIV. The expansion of HIV treatment has significantly improved TB incidence, which went down by 57% from 2015. But TB deaths only decreased by 16%.
“A lot of people continue to die and this is problematic. Of late, we noted that HIV-negative TB rates, if we look at the numbers, are going up in terms of mortality,” says Ndjeka.
This has been a setback to the country’s efforts to meet the targets set in the global plan to end TB.
Getting back on track
The Department of Health launched its TB recovery plan in 2022, after COVID-19 disrupted testing and treatment. Ndjeka say the number of people “missing” from TB care has since dropped from 160,000 annually to 58,000.
“From 2022, when we started our recovery plan, we had a 12% reduction in incidence. But we have to find TB to end TB,” he says.
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This year, the department launched its End TB campaign, which aims to test five million people during 2025/26, with the hope of diagnosing around 250,000 cases.
The focus, according to Ndjeka, is on high-risk groups such as people living in informal settlements and other high-burden communities.
Barriers to care
But intensifying testing is only half of the battle. Once people have been diagnosed with TB, it’s important to ensure that they have access to the support and resources needed to successfully start and finish their treatment.
Ndjeka says stigma is a big problem, resulting in a lot of people not accessing care. He also highlights the issue of mental health.
“A lot of patients who get TB develop depression, and they don’t seek care. Sometimes family support is an issue. But also, communities have their own problems which don’t make things easy for patients.”
The health system itself is another barrier. Many facilities remain unwelcoming, with poor staff attitudes, long waiting times, and frequent drug stockouts.
Unless South Africa can overcome both stigma and systemic barriers to care, Ndjeka warns the country will remain off track in reaching the global goal of ending TB by 2030. – Health-e News
