Tuberculosis (TB) remains one of the world's biggest killers, despite the availability of effective drugs and disease control strategies. Although epidemiological trends seem to be stabilizing in most regions of the world, Africa remains the exception with 20% annual growth in TB cases reported, largely due to concurrent HIV epidemics. South Africa ranks 2nd in the world in terms of TB incidence (number of cases per capita) and 7th in terms of TB burden (total number of cases). More than 60% of TB patients in SA are co-infected with HIV. The TB epidemic is compounded by the emergence of multidrug-resistant TB (MDR-TB) in all provinces. MDR-TB is difficult to treat and extremely expensive (up to 100 times the cost of drug-susceptible TB), and associated with HIV can result in uncontrollable epidemics with devastating economic and social consequences. Challenges posed by the goal of TB control are increasing in South Africa, largely as a result of the HIV co-epidemic and increases in TB drug resistance, now compounded by the emergence of extensively drug-resistant TB (XDR-TB) in association with HIV. Gains made in HIV/AIDS care and treatment in South Africa stand to be lost through the threat of drug-resistant TB, requiring a concerted national effort to avoid the epidemic of drug-susceptible TB being replaced by an epidemic of virtually unbeatable TB. This activity highlights the MRC's comparative advantage in addressing the key challenges of HIV associated TB and drug-resistant TB in the South African context. The MRC is acknowledged worldwide for its expertise in MDR-TB management and laboratory capability and has recently emerged as a focal point for XDR-TB expertise and management capacity development. Seed funding is required to enable MRC to coordinate/facilitate a national response to XDR-TB in SA and in the Southern Africa Development Community (SADC) region, to assist SA provinces and SADC countries in strategic planning and policy formulation, and to facilitate rapid translation of operational and programmatically relevant research results into improved policies and practices. Dissemination of validated data on drug-resistant TB as well as standardized public health information is another key need.
Aim and Objectives To assist National and Provincial Departments of Health in SA in developing an appropriate response to the challenges of M(X)DR-TB and HIV; To provide technical assistance and national coordination to accomplish the MDR-TB goals of the Stop-TB Global Plan; To assist with capacity strengthening of health services and laboratory infrastructure in Southern Africa in order to allow sound diagnosis and treatment of M(X)DR-TB patients.
