TB, MDR-TB and XDR-TB in South Africa October 2006

TB case notification 2005 > cases – cases – cases – cases < cases

TB incidence in 2005 LP MPGP NW FS KZN WC NC EC > 900/ population 700 – 899/ population 500 – 699/ population 300 – 499/ population < 299/ population

TB Case Notification All TB (423.5) (493.7) (550.1) (599.4) (645.0) PTB New Sm+ve (188.1) (217.4) (250.6) (253.2) (267.5)

Treatment Outcomes Successful Rx Completion 63.0%60.5%63.0%62.9%65.5% Cure rate53.8%49.7%50.0%50.1%50.8% Defaulter Rate 12.7%11.1%11.9%10.1%10.3% Not evaluated7.5% 9.8%9.9%

Treatment Outcomes 2004

ProvinceWorst case scenario Best case scenario KZN EC Gauteng Mpumalanga Limpopo WC NW FS SA Estimated MDR-TB burden MRC Drug Resistance Surveillance

 The poor treatment outcomes and increasing resistant TB has led to the declaration of TB as an emergency in the region, in August 2005  South Africa responded with the “National TB Crisis Management Plan”  The plan focuses on four districts with the highest case loads and poor treatment outcomes

ProvinceDistrict Size Km 2 Population District Barometer 2004 No of new TB patients reported in 2004 SCR (2004) Proposed targets by end of 2006 CR 2003 Proposed targets by end 0f 2006 Eastern Cape Nelson Mandela Metro ,028, %70%42%55% Amatole ,657, %65%31%50% Kwazulu Natal eThekwini22923,240, %60%32%50% GautengCity of Jhb16443,578, %80%61%70% District profiles and targets

Global incidence is rising at 1% due to increases In Africa and E. Europe Estimated TB incidence/100K/yr Africa - high HIV Africa - low HIV World E Europe World exc Afr EEur

XDR-TB – extensive drug resistance XDR = MDR-TB plus resistance to at least 3 of the 6 available classes of second line drugs Of 17,690 isolates from 49 countries during % were MDR and 2% were XDR XDR found in: USA: 4% of MDR Latvia: 19% of MDR S Korea: 15% of MDR XDR found in Southern Africa associated with HIV

KZN Response  Contact tracing in Msinga  Referral hospitals identified to increase bed capacity  Increased laboratory capacity for diagnosis  Surveillance established to monitor the situation

XDR-TB IN SOUTH AFRICA ProvinceXDR-TB cases DiedDefaultedOn treatment E Cape0000 F State6213 Gauteng9108 KZN Limp3000 Mpu0000 N Cape0000 N West10415 W Cape0000

Immediate  Conduct survey to determine geographical prevalence  Drug availability – PAS, Capreomycin  Training of clinicians  Dissemination of guidelines in both public and private

 Infection control –Address infrastructural problems –Triaging of patients in OPD and wards  Surveillance –Contact tracing –Increase access to microscopy services  Communication strategy –GCIS to source provider

 Review current location of M(X)DR TB hospitals and their internal accommodation arrangements

Thank you