TB/ HIV CONTROL AND MANAGEMENT IN SOUTH AFRICA Prelimanary Report on TB Data 2004 CF & 2003 TO TB/ HIV CONTROL AND MANAGEMENT IN SOUTH AFRICA Lindiwe Mvusi Prepared by Carina Idema

Estimated Global TB Burden: 2009

Estimated incidence of new TB cases: 2009

Global MDR-TB Burden: 2009

HIV Prevalence among new TB cases: 2009

10 Leading underlying natural causes of death STATSSA, Mortality and causes of death in South Africa, 2008 Findings from death notification, 2010

Trends in TB Notifications: 2000 - 9

TB Case Notifications – 2008/9

Why is case detection low? TB in children missed Screening and diagnosis in HIV positive people low Contact screening not conducted Delays in diagnosis due to Low index of suspicion by HCW Lack of awareness by communities Poor access to services – facilities/ labs

HIV PREVALENCE 2009, BY DISTRICT

Prelimanary Report on TB Data 2004 CF & 2003 TO TB and HIV Indicators 2005 2006 2007 2008 2009 TB patients tested 76988 110235 136247 150542 197448 TB patients HIV pos 35299 58249 87764 89950 114523 Co-infected started on CPT 57053 58801 64348 80954 Co-infected started on ART 11654 23344 20689 22107 48314 Total number HIV positive 458618 379672 668414 844617 HIV pos screened for TB 103056 150092 364261 433662 HIV pos diagnosed with TB 30026 15521 27391 54406 HIV pos started on IPT 2512 5642 15355 23583 Prepared by Carina Idema Prepared by Carina Idema 11

Treatment outcomes, 2000-08 Year Cure rate (%) Treatment success (%) Death rate (%) Failure rate (%) Defaulter rate (%) Transfer rate (%) Not evaluated (%) 2008 67.0 76 8.0 1.8 7.5 4.8 1.9 2007 62.5 71.7 7.4 8.2 5.1 5.9 2006 62.9 73.8 7.3 1.7 9.1 5.2 2.9 2005 57.6 70.8 10.4 5.5 4.3 2004 50.8 65.5 7.1 1.5 10.3 5.8 9.9 2003 50.9 1.2 11.2 7.0 10.2 2002 50.0 63.0 11.9 9.0 2001 49.7 60.5 6.7 11.1 12.7 2000 53.8 6.5 1.3 13.5 -

Reasons for the poor treatment outcomes Poor support systems in communities Access to health facilities Health care worker attitudes Substance/ alcohol abuse Migration Poor patient knowledge and understanding Stigma – family, community, work, clinic Poor referrals and follow up systems

Estimated burden of MDR-TB:2001 Worst case scenario Best case scenario EC 2142 1169 FS 305 212 GP 1213 660 KZN 2616 1385 LP 832 455 MP 906 484 NC - NW 592 322 WC 770 422 Total 9329 4983

Prevalence of resistance among retreatment cases MDR-TB (%) Retreatment after cure 3.4 Retreatment after failure 25.5 Retreatment after default 7.4 Retreatment after completion 6.8 Unknown/ Other 7.2 Total 6.6

TB Drug Resistance, 2001 by province NEW RETREATMENT MDR-TB Any H Any R New Retreatment EC 7.1 1.2 13.4 7.8 1.0 7.4 FS 6.4 2.4 6.9 2.9 1.8 1.7 GP 4.4 9.7 6.1 1.4 5.5 KZN 5.4 14.5 8.7 7.7 LP 12.5 10.2 6.8 MP 7.0 3.1 18.9 16.0 2.6 13.7 NC - NW 5.9 2.7 11.2 9.6 2.2 WC 5.2 0.9 6.6 3.9 Total 5.7 11.8 7.5 1.6

MDR-TB Notifications 2004-9 2005 2006 2007 2008 2009 EC 379 545 836 1092 1501 1858 FS 116 151 198 179 381 253 GP 537 676 732 986 1028 1307 KZN 583 1024 2200 2208 1573 1773 LP 59 40 77 91 85 204 MP 162 134 139 506 657 446 NC 168 155 188 199 290 631 NW 130 203 225 397 363 520 WC 1085 1192 1179 1771 2220 2078 SA 3219 4120 5774 7429 8198 9070

XDR-TB Notifications 2004-9 2005 2006 2007 2008 2009 EC 3 18 61 108 175 123 FS 1 6 4 GP 5 14 19 38 30 65 KZN 59 227 336 241 181 254 LP - 2 MP 12 NC 10 7 40 NW 9 13 WC 16 28 42 60 72 SA 85 298 464 458 488 594

Prelimanary Report on TB Data 2004 CF & 2003 TO Conclusion Good quality data, regular supervision and programme reviews as well as ongoing operational research are key to assessing programme performance and impact of interventions that are implemented. Prepared by Carina Idema Prepared by Carina Idema 19

Prelimanary Report on TB Data 2004 CF & 2003 TO Thank you for listening “STOP TB …….. BECAUSE YOU CAN” Prepared by Carina Idema