Speaking Notes: Dr. Joe Phaahla, Health Minister
Department of Health, South Africa
Closing Plenary

7th SA TB Conference: Working together to get TB control back on track

Durban International Convention Centre (ICC)
16 September 2022

The Conference Chair Prof Willem Hanekom,
The MEC for Health, KwaZulu-Natal and ALL MECs in attendance, Comrade Steve Letsike, Co-Chair of SANAC,
Deputy Ministers in attendance, SANAC CEO,
International participants, Health care professionals, Members of the Civil Society, Members of the media, Fellow South Africans, Ladies and gentlemen, Distinguished guests,

 

It’s a great pleasure for me to be with you this morning/afternoon at the 7th South African TB Conference to give closing address. Its even more pleasing that we have been able to have this fully-fledged conference 2 and half years after we were hard hit by the Covid-129 pandemic.

In November last year we were here for the International Aids Conference in Africa (ICASA), but we had to make drastic adjustments due to the break-out of the 4th wave of Omicron. One of the most devastating impacts of the pandemic was the disruptions it created in HIV and TB response.
The 7th SA TB Conference is indeed a sign that we are on the road to recovery. It has provided us an opportunity to showcase South Africa’s resilience through the COVID- 19 pandemic, as well as the milestones we have achieved in our quest to eliminate TB as a public health threat. We go away with renewed vigour to accelerate the country’s efforts against TB.

In March 2021, the South African National AIDS Council (SANAC) took a decision to extend the current National Strategic Plan for HIV, TB and STIs for the period 2017 to 2022 by an additional year to implement NSP Catch-Up Plans designed to mitigate against the impact of COVID-19.
The main aim of the Catch-Up Plans was to accelerate programme implementation and explore other interventions to fast-track progress against the targets set in the NSP. The TB catch up plans culminated in the TB Recovery Plan. I am sure that during the course of this conference you were able to reflect on the TB Recovery Plan.

Earlier this year, during the commemoration of World TB Day in March, we launched the development process of the new National Strategic Plan (NSP) for HIV, TB and STIs for the period 2023 to 2028. SANAC has made significant progress in this regard. All provincial and sector-specific consultations have been completed. There will soon be a national consensus-building consultation in order to finalise the draft NSP for public comment.

This is a critical document since it is the last one towards Agenda 2030 where SA Africa joined the world in committing to end TB and AIDS by 2030. The new NSP will have a strong emphasis on placing communities at the centre and will feature a strong focus on TB response. We have made significant strides on biomedical interventions for both TB and HIV, however, there are major social problems that require non- biomedical solution and general social behaviour change – and improvement of socio- economic conditions.

Our scientists have done a great job as seen throughout the various tracks of the conference, now we need to ensure that the TB programme implementation is truly multisectoral and patient, community-centred. We should draw lessons from the country’s unity in responding to HIV and COVID-19 – the same should be applied to TB.

Ladies and gentlemen, the SA TB prevalence Survey conducted in 2018 revealed that South Africa is one of the 30 high burden tuberculosis (TB) countries in the world, with
the highest incidence rate for TB when adjustments are made on population size. The COVID-19 pandemic exacerbated the situation, but we have taken steps to recover lost ground. The Strategic plan that is being currently developed will feed into the HIV, TB, STIs National Strategic plan.
At the first Global Ministerial Conference on Ending TB convened by the World Health Organisation in November 2017 Heads of States and the UN High Level, including South Africa, committed to drive and support a multisectoral response to TB. There was also a call for countries to develop a Multisectoral Accountability Framework (MAF) for TB. The WHO developed a framework for this work. The MAF aims to guide and strengthen accountability by members, as well as multisectoral partners and stakeholders to accelerate progress to end the TB epidemic by 2030. From Monday I will be in New York where amongst others we will discuss the next UN High Level – 2023 on TB.

As part of the TB Recovery Plan, we shall introduce shorter and more cost-effective regimens that are key for treatment adherence. Affordability of medicines continues to be a challenge and we urge pharmaceutical companies to partner with government to improve access not only to prevention regimens but also to medicines for treating multidrug resistant TB. What also remains paramount in our response, is the strengthening of access to psychosocial, nutritional and socio-economic support to ensure successful treatment completion.

We recently approved the latent TB infection therapy guidelines. We need to launch these guidelines and we shall ensure training at all levels for better implementation. Currently, the well-performing 3HP, a preventive therapy regimen, is mostly available in Global Fund supported districts and we need to change that to ensure that it is accessible across the country.

I am informed that the 4 conference tracks provided a massive learning opportunity to participants. The extent of topics varied from the pathogenesis of TB, the drugs/vaccines/diagnostics, the implementation and health systems as well as social and community aspects.
Some take home messages include the following:

Nothing should be higher on Government’s agenda than addressing the number one killer of our people
The Government’s response to the setbacks due to Covid-19 is captured in the TB Recovery plan
The TB Recovery Plan has been praised by stakeholders from many constituencies
South African Researchers are at the cutting edge of testing new drugs, vaccines and diagnostics, which are going to impact the TB epidemic in South Africa.
A theme throughout the conference has been about limited access to TB data that could be used by many stakeholders to guide approaches that will impact TB. This matter needs Government’s attention.
A call for greater collaboration between researchers, implementers and communities/users

Track 1: Pathogenesis of tuberculosis – the pathogen and the host

The conference had several presentations in this important area. Some of these presentations discussed a novel understanding of lung pathology in tuberculosis. We are hoping that research in this area will be adequately funded so we can get these testing methods in our facilities.

Track 2: Vaccines/drugs/diagnostics

The conference heard that there are 14 TB vaccine candidates; of these 4 are in phase 3: VPM, MTB VAC, BCG revaccination and M72. M72 is the only vaccine candidate that has shown more than 50 % efficacy against progression to TB disease. This is another undertaking that requires massive funding. We need TB vaccines to accelerate the END of TB.
Regarding drugs: the conference presented data from several shorter drug- susceptible (4 months) and drug-resistant tuberculosis (6 months). These novel, shorter, all-oral regimens for drug-resistant TB such as Nix study, Zenix study and Practecal have produced impressive favorable treatment outcomes (90 % or more treatment success rate). I am also informed that participants showed a lot of interest
and commanded the TB recovery plan for including shorter DR-TB regimens (6 months) and shorter paediatric regimen for drug-susceptible TB (4 months).
Many drugs are in the pipeline, this is encouraging. Shorter TB preventive therapy regimens were also discussed, particularly 3HP (3 months of a combination made of rifapentine and isoniazid taken on weekly basis). I have been informed that conference participants welcomed the expansion of TPT to all households’ contacts regardless of age and HIV status.
The need for child friendly TB formulations was also highlighted. There are ongoing trials for children and pregnant women who are often excluded from clinical trials.
The conference heard that the XDR-TB cartridge will be introduced for all rifampicin- resistant TB patients by November 2022. This will shorten time to diagnosis among rifampicin-resistant tuberculosis patients. The audience also lamented the reduced supply of genexpert cartridges and requested that the price of genexpert be reduced.

Track 3: Health systems

The need for locally driven solutions was highlighted. Communities to be part of the solution.
The conference learned that among children, adolescents are at the greatest risk for TB and initiatives to improve retention of adolescents on treatment are complex and special attention needs to be paid.
One of the major issues to emerge from this track was how many people with TB have co-morbidities. We are screening routinely at clinics for TB and HIV, shouldn’t we also be screening for diabetes and hypertension at the same time?
Another issue that emerged from qualitative work was that community level people relied on clinics for information on TB. Although they didn’t want to go to the clinic for treatment and sought health from different sources, the only information they trusted was that from clinics. One of the problems, however, is that so little information on TB is available at clinics – maybe a few tattered posters, but no leaflets for them to take home to read and understand.
There were many learnings from projects which implemented Chest X-Rays with CAD, urine LAM and TB Preventive therapy.
A field guide recommending best practices for the management of pregnant and postpartum women with DR-TB was launched.

Track 4: Social aspects

Many impressive studies that focused on social aspects were presented. Some of these looked at the impact of stigma on care-seeking and outcomes. Stigma is real, it is a challenge, and it has a negative impact on treatment outcomes.
Patient’s support was highlighted as an important factor to improve treatment outcomes.
The role of leaders in supporting the fight against tuberculosis was extensively discussed. It was reported that only 4 provinces have provincial TB caucuses; the other 5 including our host province do not have.
Leaders and civil society need to be fully involved in health issues regarding their communities/constituencies. TB & HIV are social conditions.
I need a detailed report of the conference proceedings in order to take decisive steps. It is good to learn; although implementation is what we need.
An unprecedented, very active participation of civil society and political leadership to a TB conference has been noticed. This is testimony to the fact that SANAC is working closely with the National Department of Health and the National TB Programme in particular.

As we walk away from this conference, I’d like us to remain conscious of the following facts – TB remains the leading cause of death in the country, particularly to people living with HIV. The Global TB report of 2021 quoted 61 000 who had died of TB and 31 000 of those were people living with HIV during the year 2020, translating to 167 deaths per day. High death rate and high loss to follow up are the main features of our TB response. We need to work hard to reverse these in order to improve favourable treatment outcomes among our TB patients.
There is high TB among men than women, indicating the need for interventions targeting men. The TB Prevalence Survey also highlighted that the youth and the elderly are also among the hardest hit.

Our interventions should be targeted,

Our responses should be patient-centred and community-centred, Our approaches should be nuanced and,
Our efforts should be multisectoral!

I thank you.