South Africa is one of the countries with the highest burden of TB, with the World Health Organisation (WHO) statistics giving an estimated incidence of 454,000 cases of active TB in 2015.1Global Tuberculosis Control 2016, WHO, Geneva, 2016 www.who.int/tb/en So about 0.8% of the population of about 54 million develop active TB disease each year.
The TB incidence for any country is the number of new cases, usually of active TB disease that have occurred in the country during a certain time period which is usually a year. Out of the 454,00 incident cases in South Africa in 2015, it is estimated by WHO that about 57% (258,000) are HIV positive.
It is also estimated that of 157,505 whose status is known, and who are known to be HIV positive, some 85% (133,116) are on antiretroviral therapy.2Global Tuberculosis Control 2016, WHO, Geneva, 2016 www.who.int/tb/en For more HIV figures see HIV South Africa and for more about HIV generally see HIV & TB in South Africa.
It is also estimated that about 80% of the population of South Africa is infected with TB bacteria, the vast majority of whom have latent TB rather than active TB disease. The highest prevalence of latent TB, estimated at 88% has been found among people in the age group 30-39 years old living in townships and informal settlements.3National Strategic Plan on HIV, STIs and TB 2012-2016, South African National AIDS Council, 2011 www.gov.za/documents/national-strategic-plan-hiv-stis-and-tb-2012-2016
TB continues to be the leading cause of death in South Africa (further details are given below). WHO gives a figure of 25,000 deaths from TB in South Africa in 2015 but this excludes those people who had both TB and HIV infection when they died.4Global Tuberculosis Control 2016, WHO, Geneva, 2016 www.who.int/tb/en These people are internationally considered to have died of HIV.
The TB incidence rate is the proportion of new TB cases per 100,000 population over a year. In South Africa the TB incidence rate reached its peak in 2009 at 832 per 100,000, and has since declined.
The Eastern Cape, KwaZulu-Natal and the Western Cape are the provinces which have the highest incidence rates in South Africa with reported rates of 692, 685 and 681 per 100,000 respectively. The most notable decline has been in KwaZulu-Natal where the incidence has decreased from 1,185 to 685 per 100,000 over the last five years.
|Number of TB patients started on TB treatment||325,498||339,379||354,270|
|Number of patients successfully treated||251,344||264,455||269,624|
|Treatment success rate %||77.2||77.9||76.1|
The cure rate is the number of cases per 100,000 population where the patient has finished the course of treatment, and there is bacteriological evidence that this has been successful. The treatment success rate is the combination of the cure rate, added to the rate of completion where the course of TB drugs has been completed but there isn’t bacteriological evidence of success. In other words both “success” and “cure” is when the course of drugs has been completed, and for “cure” there in addition has to be bacteriological evidence.
|Number of new smear positive patients cured||74,737||89,368||92,685|
|Total number of new smear positive patients||96,607||116,349||122,302|
|Cure rate for new smear positive TB (%) %||77.4||76.8||75.8|
The TB lost to follow up rate measures the proportion of new pulmonary smear positive TB patients who interrupted treatment for two consecutive months or more.
The national lost to follow up rate was 5.6% in South Africa in 2014. This was a marginal improvement from 5.8% in 2013.
TB treatment outcomes in South Africa by province 2014.
|Province||Treatment success rate %||Cure rate %||Lost to follow up %|
TB remained the leading cause of death in South Africa in 2014 with 8.4% of deaths nationally attributed to TB.5Statistics South Africa. Mortality and causes of death in South Africa 2014. Findings from death notifications. Pretoria: StatsSA 2015 However, the proportions of deaths due to TB has decreased significantly since 2007 when it peaked at 12.8%.
|2014 %||2013 %||2012 %||2011 %||2010 %|
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District Health Barometer 2015/16 Massyn N, Peer N, English R, Padarath A, Barron P, Day C, editors, District Health Barometer 2015/16 Durban Health Systems Trust; 2016 www.hst.org.za/publications/Pages/HSTDistrictHealthBarometer.aspx
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|1.||↑||Global Tuberculosis Control 2016, WHO, Geneva, 2016 www.who.int/tb/en|
|2.||↑||Global Tuberculosis Control 2016, WHO, Geneva, 2016 www.who.int/tb/en|
|3.||↑||National Strategic Plan on HIV, STIs and TB 2012-2016, South African National AIDS Council, 2011 www.gov.za/documents/national-strategic-plan-hiv-stis-and-tb-2012-2016|
|4.||↑||Global Tuberculosis Control 2016, WHO, Geneva, 2016 www.who.int/tb/en|
|5.||↑||Statistics South Africa. Mortality and causes of death in South Africa 2014. Findings from death notifications. Pretoria: StatsSA 2015|