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

2. TB case notification 2005 > 60 000 cases 40 000 – 59 999 cases 20 000 – 29 999 cases 10 000 – 19 999 cases < 9 999 cases

3. TB incidence in 2005 LP MPGP NW FS KZN WC NC EC > 900/100 000 population 700 – 899/100 000 population 500 – 699/100 000 population 300 – 499/100 000 population < 299/100 000 population

4. TB Case Notification 20012002200320042005 All TB 188 695 (423.5) 224 420 (493.7) 255 422 (550.1) 279 260 (599.4) 302 467 (645.0) PTB 144 910182 583215 154234 213257 604 New Sm+ve 83 808 (188.1) 98 800 (217.4) 116 337 (250.6) 117 971 (253.2) 125 460 (267.5)

6. Treatment Outcomes 20002001200220032004 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%

7. Treatment Outcomes 2004

8. ProvinceWorst case scenario Best case scenario KZN2 5611 356 EC2 1811 190 Gauteng1 239673 Mpumalanga928496 Limpopo779426 WC696382 NW511278 FS281195 SA9 7275 196 Estimated MDR-TB burden MRC Drug Resistance Surveillance 2001 -2002

9.  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

10. 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 1 9521,028,016811560%70%42%55% Amatole23 6751,657,901790653%65%31%50% Kwazulu Natal eThekwini22923,240,5172419849%60%32%50% GautengCity of Jhb16443,578,3921532372%80%61%70% District profiles and targets

11. Global incidence is rising at 1% due to increases In Africa and E. Europe 0 100 200 300 400 1990199520002005 Estimated TB incidence/100K/yr Africa - high HIV Africa - low HIV World E Europe World exc Afr EEur

12. 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 2000-2004 20% 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

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

14. XDR-TB IN SOUTH AFRICA ProvinceXDR-TB cases DiedDefaultedOn treatment E Cape0000 F State6213 Gauteng9108 KZN787404 Limp3000 Mpu0000 N Cape0000 N West10415 W Cape0000

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

16.  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

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

18. Thank you