The twin storms of HIV and tuberculosis are colliding, with Western Cape townships at the epicentre, notching up TB rates 150 times higher than the national rates in many high-income countries.
HIV-TB, (The TB formerly known as XDR-TB) deadlier and more difficult to diagnose and treat than either disease alone, has taken hold here, with some areas recording up to an eight-fold spiral in their TB caseload since 1996.
The Western Cape is in the spotlight in a new report released on Friday, HIV-TB (The TB formerly known as XDR-TB) Co-infection: Meeting the Challenge, which reflects an unprecedented consensus among leading global health organisations on the need for action before the co-epidemic spreads globally.
The call is echoed by local specialists who warn that laboratory facilities here are being swamped with demand for testing, while health staff are demoralised and struggling to cope.
The report details a study of an unnamed local township, with a population of about 13,000 people, where the TB clinic had seen a six-fold increase in TB patient caseload between 1996 and 2004.
The rise in TB incidence mirrored that of HIV prevalence, which climbed from 6 percent to 22 percent during the same period.
On Friday, according to research specialist Dr Stephen Lawn, that increase was more than eight-fold and he stressed that the situation was not unique to that single township.
"That level of problem is occurring in many other townships of Cape Town where we are seeing disease levels of that magnitude," said Lawn, a clinician scientist at UCT's Desmond Tutu HIV Centre.
First detected 23 years ago, HIV-TB (The TB formerly known as XDR-TB) now affects nearly one-third of the 40-million people infected with HIV worldwide.
Without proper treatment, 90 percent of people living with HIV die within months of contracting TB.
The report said the situation was made even more urgent by the surging rates of multi-drug resistant TB in some areas with high HIV prevalence.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected, and where drug-resistant TB is silently spreading," said Veronica Miller, co-author of the report and director of the Forum for Collaborative HIV Research.
"It is here now. But the science and co-ordination needed to stop it are utterly insufficient," she said.
Lawn said that in South Africa generally, and in the Western Cape specifically, health authorities had a responsibility to provide the necessary resources to treat patients.
"Clinics are understaffed to deal with the huge numbers of people attending and it's becoming more and more difficult to make sure patients complete their full course of treatment.
"Manpower, facilities and administration resources haven't kept pace with the growth in patient numbers," he said. This was also demoralising for staff who were "working their socks off" while the epidemic continued growing.
On testing, the report authors warned that the standard diagnostic test for TB, invented 120 years ago, failed to detect between 40 percent and 80 percent of TB cases in those with HIV-TB. {(The TB formerly known as XDR-TB) RefX1; RefX2; RefX3; RefTB}
A more advanced test does exist and Lawn said that while the new tests were not an option for most of Africa, "for SA they are".
"But ... there is a serious need for greater resources to support the laboratories in the diagnosis of TB," he said.
Lawn said of the Western Cape that "when you have TB rates in your communities that are the highest in the world, it really should take very high priority in terms of the politicians and health spend". - Cape Argus
HIV-TB, (The TB formerly known as XDR-TB) deadlier and more difficult to diagnose and treat than either disease alone, has taken hold here, with some areas recording up to an eight-fold spiral in their TB caseload since 1996.
The Western Cape is in the spotlight in a new report released on Friday, HIV-TB (The TB formerly known as XDR-TB) Co-infection: Meeting the Challenge, which reflects an unprecedented consensus among leading global health organisations on the need for action before the co-epidemic spreads globally.
The call is echoed by local specialists who warn that laboratory facilities here are being swamped with demand for testing, while health staff are demoralised and struggling to cope.
| 'That level of problem is occurring in many other townships of Cape Town' |
The rise in TB incidence mirrored that of HIV prevalence, which climbed from 6 percent to 22 percent during the same period.
On Friday, according to research specialist Dr Stephen Lawn, that increase was more than eight-fold and he stressed that the situation was not unique to that single township.
"That level of problem is occurring in many other townships of Cape Town where we are seeing disease levels of that magnitude," said Lawn, a clinician scientist at UCT's Desmond Tutu HIV Centre.
First detected 23 years ago, HIV-TB (The TB formerly known as XDR-TB) now affects nearly one-third of the 40-million people infected with HIV worldwide.
| 'the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected' |
The report said the situation was made even more urgent by the surging rates of multi-drug resistant TB in some areas with high HIV prevalence.
"Now the eye of the storm is in sub-Saharan Africa, where half of new TB cases are HIV co-infected, and where drug-resistant TB is silently spreading," said Veronica Miller, co-author of the report and director of the Forum for Collaborative HIV Research.
Unlike bird flu, the global threat of XDR/HIV-TB is not hypothetical.
"It is here now. But the science and co-ordination needed to stop it are utterly insufficient," she said.
Lawn said that in South Africa generally, and in the Western Cape specifically, health authorities had a responsibility to provide the necessary resources to treat patients.
"Clinics are understaffed to deal with the huge numbers of people attending and it's becoming more and more difficult to make sure patients complete their full course of treatment.
"Manpower, facilities and administration resources haven't kept pace with the growth in patient numbers," he said. This was also demoralising for staff who were "working their socks off" while the epidemic continued growing.
On testing, the report authors warned that the standard diagnostic test for TB, invented 120 years ago, failed to detect between 40 percent and 80 percent of TB cases in those with HIV-TB. {(The TB formerly known as XDR-TB) RefX1; RefX2; RefX3; RefTB}
A more advanced test does exist and Lawn said that while the new tests were not an option for most of Africa, "for SA they are".
"But ... there is a serious need for greater resources to support the laboratories in the diagnosis of TB," he said.
Lawn said of the Western Cape that "when you have TB rates in your communities that are the highest in the world, it really should take very high priority in terms of the politicians and health spend". - Cape Argus
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