Opening Remarks by KZN Health MEC, Dr Sibongiseni Dhlomo on the occasion of the official opening of the SA TB Conference at International Convention Centre in Durban, 10 June 2014

• 75% reduction in tuberculosis deaths (compared with 2015)
• 50% reduction in tuberculosis incidence rate (less than 55 tuberculosis cases per 100 000 population)
• No affected families facing catastrophic costs due to tuberculosis

Indeed, we remain concerned that Tuberculosis (TB) still continues to remain a major global health problem as the World Health Organisation reveals that in 2012, an estimated 8.6 million people developed TB and that a total of 1.3 million people also died from this disease. Amongst those who demised 320 000 of them were HIV-positive.

It is further revealed that even though most TB cases and deaths occur among men; TB remains among the top three killers of women worldwide. In 2012 for an example, globally, there were an estimated 410 000 TB deaths among women.
The children are also not left immune in this, considering that in the same reporting period, globally, you had a total estimate of 530 000 TB cases among children (under 15 years of age) and 74 000 dying.

Coming back to South Africa; in 2012, the rate of infection was 450 000 cases with an estimated 88 000 deaths of which KwaZulu Natal accounted for 31% of all TB cases reported in the country at 101 037 cases; 7 884 of those cases being children under the age of 5 years.
Programme Director; these big numbers of people dying of Tuberculosis are unacceptable given the fact that TB is a preventable and curable disease.

I thus consider it prudent that we first take stock of what we have been doing as a country in an attempt to manage and eradicate this malady.
The South African National Department of Health started providing Antiretrovirals in 2004. The ground breaking pronouncements on World AIDS day in December 2009 by Hon President, Jacob Zuma came with innovative approaches that entailed:

• President Zuma’s call for the integration of HIV management and TB treatment, that TB and HIV to be treated under one roof and those patients with TB-HIV be started on ARVs. Here in KwaZulu-Natal, the integrated TB/HIV services are now accessible and available in all the 779 health public health facilities.
   
• Our country also has the largest number of Gene Xpert machines in the world and this has facilitated the early diagnosis of TB and MDR-TB allowing initiation of TB treatment within 24-48 hours and reduced the time for treatment of MDR TB from 2 months to less than 2 weeks.As expected, KwaZulu Natal with the highest TB prevalence also accounts for the majority of these revolutionary machines as it has 86 Gene Xpert machines spanned all over the Province.
   
• We also now have the Nurse driven ART initiation on TB, the NIM DR (nurse initiated drug resistant MDR-TB treatment) which is still being rolled out and expected to be in full implementation before the end of the year.
   
• We also have TB defaulter tracing teams and TB/HIV outreach teams; 102 in KZN, who are supported by Community Care Givers. These cadres visit households to provide Directly Observed Treatment and watch patients drink medicine, with special emphasis on those with drug resistant TB who stay for 24 - 36 months on treatment.
   
• Efforts are also been made to identify TB hot spots in the communities; correctional facilities; hostels; Taxi Ranks; Truck Stops and coal mines. Focus interventions in those areas are being initiated working in collaboration with sectors concerned.
   
• Expanding Medical Male Circumcision and other HIV prevention interventions is also a means to prevent new infections and halt the further spread of HIV as well as identify and manage TB.
   
• TB is a significant occupational health problem among Health Care Workers. It is crucial to implement and sustain effective surveillance programmes for Health Care Workers. We need to pay more attention to the surveillance programs to protect the Health Care Workers from acquiring TB.
   
• Community awareness campaigns around TB symptoms, HIV testing and encouraging early presentation to the facilities are an on-going effort. Emphasis in these campaigns is on discouraging Stigma and Discrimination which are major barriers to testing and access to care.
   
• Resources have been committed for training of health care workers in all sectors not only to improve the quality of care delivered to our patients, but also to retain and protect the health care workers from TB and other infectious diseases.
   
• Appreciating that we are in a globalized world, South Africa is also collaborating with SADC partners in addressing the scourge of TB which spreads far and wide through regional and international travel. The National Department of Health lead efforts to establish a multi stakeholder committee on TB in the mining sector to provide an effective response to TB in the mining sector which has long been recognized as a public health problem in the mining sector.
   
• Programme Director, we cannot talk about TB and not mention Poverty. Poverty and diseases are inter-linked. Poverty is the underlying factor in TB disease. We also know that TB disproportionately affects the poor with devastating economic impact on families. As we deliberate the advances in research and the strategies to prevent and treat TB, we need to also address issues around poverty by identifying the most vulnerable groups and review situations of those groups in need of special consideration.
   
• We cannot lose hope that the potential to reach the millennium development goal 6 is still there and as a country remain committed to strive toward this through:
   
• HIV prevention especially in young girls
• TB control by active case finding and improving cure rates
• Social mobilization for wide scale public health action
   
• We recognise the need to integrate the prevention of non-communicable disease and improve the control of these through an integrated health systems strengthening approach
   
• We invite civil society to work alongside us by actively participating in clinic committees, engaging with communities and using their resources to complement the efforts of the formal public health system
   
• In essence, Programme Director, South Africa has the political will and resources ploughed to put into action all the Pillars for 2015 TB Strategy which are:
• Early diagnosis of tuberculosis including universal drug-susceptibility testing; and systematic screening of contacts and high-risk groups
• Treatment of all people with tuberculosis including drug-resistant tuberculosis; and patient support
• Collaborative tuberculosis/HIV activities; and management of comorbidities
• Preventive treatment of persons at high risk;
   
• We thus look forward to the collective wisdom of the delegates gathered here to advise us on how best and what more should be done.
  We are encouraged by the choice of the three thematic tracks, chosen that seeks to address the key issues hampering elimination of TB from human society; these being:
• Detection and Prevention of TB
• TB Treatment
• TB Management