The Second Greatest Cause of Death Due to a Single Infectious Agent: Tuberculosis

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Introduction
Tuberculosis (TB) is the second greatest cause of death due to a single infectious agent with majority of deaths occurring in low and middle income countries1. The often fatal combination with HIV has further complicated the situation along with multi-drug and extensive drug resistance. South Africa, a middle-income country, bears a large burden of the TB problem with exceptionally high rates of HIV/TB co-infection and drug-resistance. South Africa has an incidence of 1,003 TB cases per 100,000, a prevalence of 857 TB cases per 100,000, and mortality of 59 per 100,0002, ranking as the third highest in TB burden in the world just behind China and India3. In 2012, the incidence of HIV/TB co-infection was 631 per 100,000 and 6.7% of retreatment cases were shown to be multi-drug resistant2, adding to the propensity of the TB problem in the country.
Program Rationale
South Africa is in national partnership with the STOP TB organization and has implemented a national tuberculosis control program starting in 2004 with added political commitment of a tuberculosis strategic plan in 2007. This national program advocates the message and mission of The Global Plan to Stop TB, an initiative within the STOP TB partnership. The Global Plan to Stop TB (Part I) identifies the strategic directions in order to meet goals of ensuring effective TB diagnosis, treatment and cure and stopping the transmission of TB among numerous other objectives. By implementing the STOP TB strategy through its national tuberculosis control program, South Africa sets forth goals for TB control specifying that it aims to “reduce mortality and morbidity attributable to TB, prevent the development of drug resistance, and ensure accurate measurements and eval...

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...uence access to care. Focusing efforts on key populations and mitigating developmental challenges such as education and employment and other societal inequalities are crucial to furthering the response to the TB control program3. Testing for HIV in TB patients should become common practice. Decentralization continues to show benefits by providing more opportunities for care and adequate treatment to MDR-TB patients. However, adequate training and supervision of healthcare workers should be ensured. Continued government support is crucial to the sustained success of the program as much has already been accomplished through government and domestic funding. Monitoring and evaluation efforts should continue to inform future planning and decisions. All in all, South Africa still has much to do on all fronts to curb TB infections and deaths and to meet its program goals.

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