TB

Background

The healthcare workforce in high tuberculosis burden countries such as South Africa is at elevated risk of tuberculosis infection and disease with adverse consequences for their well-being and productivity. Despite the availability of international guidelines on protection of health workers from tuberculosis, research globally has focused on proximal deficiencies in practice rather than on health system barriers.

Objective

Background
HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.

Background

Retreatment tuberculosis (TB) disease is common in high-prevalence settings. The risk of repeated episodes of recurrent TB is unknown. We calculated the rate of recurrent TB per subsequent episode by matching individual treatment episodes over a period of 13 years.

Methods

Darunavir/ritonavir administered with rifampicin causes hepatotoxicities in people living with HIV, according to results of a study led by researchers at the department of medicine, the Wellcome Centre for Infectious Diseases Research in Africa (CIDRI-Africa) and the Desmond Tutu HIV Centre at the University of Cape Town. Darunavir/ritonavir-based antiretroviral therapy (ART) is better tolerated and has a higher genetic barrier to resistance compared with second-line lopinavir/ritonavir-based ART for treatment of HIV.

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In 2017, tuberculosis caused an estimated 1·6 million deaths, including 300 000 deaths among people with HIV, and surpassed HIV/AIDS to become the leading infectious cause of mortality worldwide. Approximately 36% of tuberculosis cases each year (around 3·5 million cases) are not diagnosed or reported, which might have contributed to the increase in tuberculosis prevalence.

With only a year until 2020 – and the deadline to reach the 90-90-90 targets – South Africa is dangerously off track. Currently 7.1 million people are living with HIV in the country. New HIV infections remain high, according to the Thembisa model1 at 275 000 in 2017, higher than the 231 000 estimated in the Human Sciences Research Council (HSRC) survey.