HIV and TB continue to cause significant morbidity and mortality in many communities across South and Southern Africa. This is despite improved availability of antiretroviral therapy over the past decade, a test-and-treat approach to diagnosis and initiation of treatment, and improved patient education.
So what’s next in the battle against HIV and TB in South Africa?
South Africa's latest National Strategic Plan (NSP) for HIV, TB, and STIs (2023–2028) focuses on new medications highlighting the potential for long-acting options, pre-exposure prophylaxis (PrEP), improved TB diagnostics, and greater integration of care.
National strategic plan
https://sanac.org.za/wp-content/uploads/2023/05/SANAC-NSP-2023-2028-Web-Version.pdf
New Medications and Long-Acting Solutions
TLD (tenofovir-lamivudine-dolutegravir) is the preferred first-line antiretroviral therapy (ART). It comes as a single combination tablet to be taken once a day, with minimal side effects. This has revolutionized ART treatment, improving adherence and reducing resistance rates compared to previous regimens. The HIV community is also excited about the prospect of long-acting antiretroviral options – currently being used as pre-exposure prophylaxis (PrEP) but hopefully available as treatment options in the coming years. These long-acting options (such as injectable treatments taken once every 3-6 months) meet the needs of key populations like adolescent girls and young women (AGYW), who remain disproportionately affected by HIV.
Pre-Exposure Prophylaxis (PrEP)
Expanding access to PrEP is pivotal in reducing new infections. Initiatives include tailored education campaigns and simplified delivery mechanisms to reach underserved communities. Integration into mobile and community-based health programs ensures PrEP's availability for those in remote and high-risk areas.
Starfish Case Study: Starfish Greathearts Foundation in partnership with the Community Based Organisation in KZN’s Wellness Wagon Programme brings mobile health services to underserved communities, providing TB and HIV education, screening, and referrals for further care. One success story involves Lindiwe (name changed), a 23-year-old, who learned about PrEP during a community workshop facilitated by the health workers. After her screening, she was linked to a local clinic to begin PrEP, dramatically reducing her risk of HIV infection.
Tuberculosis (TB) Innovations
Cutting-edge diagnostic and therapeutic tools, including molecular diagnostics and shorter treatment regimens for multidrug-resistant TB (MDR-TB), are key innovations to combat TB. To bridge the gap of undiagnosed cases, community screening programs now utilize digital chest X-rays, which effectively detect TB without the need to see a doctor.
Starfish Case Study: Through collaboration with local clinics, Starfish health workers identified Thabo (name changed), a 9-year-old boy with prolonged cough and weight loss, during a routine home visit. Using digital chest X-ray technology as part of a mobile TB screening drive, Thabo was diagnosed and immediately started on treatment, making a full recovery.
Integrated Care and System Resilience
Efforts to integrate HIV and TB services with broader healthcare systems are ongoing, addressing co-infections, mental health, and non-communicable diseases. Improvements in laboratory capacity and expediting the approval of new health technologies remain a priority.
Starfish Case Study: In Eastern Cape, Starfish health workers help patients with HIV and TB navigate the healthcare system, providing critical education on medication adherence and emotional support. Nomsa (name changed), living with both conditions, credits Starfish’s integrated care model with helping her manage her treatment effectively and regain her health.