Tuberculosis (TB), a treatable infection, continues to be one of the leading causes of death in South Africa. Despite ongoing progress towards eradicating this centuries-old disease, much work remains. In this effort, South Africa has hosted a TB Conference every two years since 2008, bringing together some of the foremost experts in TB research. This year, the conference was chaired by Associate Professor Sizulu Moyo from the HSRC, who spoke to Jessie-Lee Smith about some of the most pressing TB concerns in South Africa and how HSRC research is contributing to addressing these.

On 24 March 1882, Dr Robert Koch identified Mycobacterium tuberculosis as the bacteria that causes tuberculosis (TB). By this time, TB had been infecting and killing people globally for centuries, under names like ‘the white plague’ and ‘consumption’. Today, TB remains a leading cause of death from infectious diseases around the world and a significant contributor to deaths in South Africa.

Chaired by the HSRC’s Professor Sizulu Moyo, South Africa’s 8th Annual TB Conference took place in Durban in June 2024. It was attended by some of the nation’s leading experts in TB research, including several top HSRC researchers.

In her opening address, Moyo reminded attendees about the ongoing social, psychological, and economic suffering caused by TB, despite it being a curable disease. “In 2022, an estimated 280,000 people in South Africa contracted TB, and 54,000 died from it. To put the mortality data into perspective, approximately one person died every 10 minutes from TB. Think about it – it’s a mother, a father, a brother, a sister, a neighbour, a colleague. These losses are real and close to us,” she said.

The HSRC hosted a session titled Understanding TB in South Africa: Knowledge, prevention, screening and therapeutic thresholds. The session shared findings of studies undertaken by the HSRC and included a presentation on programme data from KwaZulu-Natal by Jacqueline Ngozo.

Presenting at this session, the HSRC’s Dr Rindidzani Magobo shared findings from the Sixth South African National HIV Prevalence, Incidence and Behaviour Survey (SABSSM VI), which showed that almost 60% [of people living with HIV] were unaware that TB was a leading cause of death in South Africa. “Understanding the population’s knowledge about TB is one of the first steps towards preventing and managing the disease,” Magobo said. Misinformation and misconceptions are dangerous because they can foster stigma against people infected with TB. “Myths about TB are perpetuated when conversations about the disease happen behind closed doors,” Moyo told the HSRC Review, imploring that there be open and honest conversations about the disease.

HSRC research has contributed to highlighting the pervasiveness of TB stigma in South Africa. According to The People Living with HIV Stigma Index 2.0, an HSRC study conducted from 2020 to 2021, 11.5% of people living with TB reported being gossiped about, while 9.6% were teased, insulted or sworn at. The SABSSM VI report also indicates that 9.8% of respondents reported being teased, insulted or sworn at and 11.7% were gossiped about. Stigma often leads individuals to delay seeking medical help or desist from treatment due to fears of discrimination.

Moyo stressed the importance of everyone having the correct information about what causes TB, the symptoms of TB, and the reasons why some people are at greater risk of getting TB. Several common myths about TB are dispelled in Table 1.

Table 1. Common myths and truths about TB

MYTHS	TRUTHS
All individuals with TB have HIV.	Anyone can get TB. Those with HIV are more susceptible because of a weakened immune system.
TB is caused by a virus and cannot be cured.	TB is caused by a bacteria and it can be cured with TB medicines.
Only poor people and people living in informal settlements get TB.	Anyone can get TB. However, it spreads more easily in crowded living conditions and in areas with poor ventilation.
Touching or being close to someone with TB will infect you with the disease.	The bacteria that causes TB becomes airborne when someone who is infected coughs, sneezes or spits, and is transmitted through the air.

TB can be prevented and can also be cured if treatment is strictly adhered to over the required treatment period. This period can last for six months; this lengthy duration means there are numerous opportunities for patients to discontinue their treatment prematurely. People with untreated or incompletely treated TB can pass TB on to others in their homes, communities, workplaces, and places of leisure. One person with untreated TB can infect between 12–15 people per year.

At the HSRC session, Dr Adrienne Shapiro, a collaborator from the University of Washington, presented a study, which aimed to see how different service delivery methods affected adherence to a preventative treatment known as isoniazid preventive therapy (IPT). This study also led to TB diagnoses and the identification of individuals who could benefit from TB preventative treatment (TPT).

While TB treatment is free in South Africa, poverty remains a barrier to medicine adherence, says Moyo. According to a recent study of TB patients in rural South Africa, 28% of participants experienced what is called ‘catastrophic costs’ because of treatment-related expenses. The HSRC TB Triage+ study is helping to improve the uptake and completion of TPT and to support new short-course TPT implementations, therefore decreasing future costs of treating active TB.

Evaluating new diagnostic tests in different settings, focusing on how quickly patients are diagnosed and treated, and ensuring they stay in care is crucial for improving TB elimination efforts. The HSRC’s Dr Shannon Bosman expressed how the TB Triage+ study is experimenting with new TB diagnostic methods.

According to Bosman, the study supported the efficacy of digital chest x-rays, which were analysed by artificial intelligence, and point-of-care tests conducted and evaluated at the testing sites, using blood samples, to diagnose people with presumptive TB. Presumptive TB refers to individuals who exhibit symptoms or clinical signs suggesting TB, who require further diagnostic testing to confirm the disease.

The HSRC continues efforts to promote TB eradication and to reach the UNAIDS target of 95-95-95 by 2028. This target refers to 95% of South Africans knowing their HIV and TB status, 95% of individuals infected with HIV or TB being on treatment, and 95% of those infected with HIV or TB being virally suppressed or cured, respectively.

Research contact:

Professor Sizulu Moyo, a strategic lead in the HSRC Public Health, Societies and Belonging Division

smoyo@hsrc.ac.za

Read more about TB stigma here.

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