1. TB, MDR-TB and XDR-TB in South Africa October 2006

2. TB case notification 2005 > 60 000 cases 40 000 – 59 999 cases 20 000 – 29 999 cases 10 000 – 19 999 cases < 9 999 cases

3. TB incidence in 2005 > 900/100 000 population 700 – 899/100 000 population 500 – 699/100 000 population 300 – 499/100 000 population < 299/100 000 population LP GP MP NW FS KZN NC EC WC

4. TB Case Notification

6. Treatment Outcomes

7. Treatment Outcomes 2004

8. Estimated MDR-TB burden MRC Drug Resistance Surveillance 2001 -2002

9. The poor treatment outcomes and increasing resistant TB has led to the declaration of TB as an emergency in the region, in August 2005 • South Africa responded with the “National TB Crisis Management Plan” • The plan focuses on four districts with the highest case loads and poor treatment outcomes

10. District profiles and targets

11. Global incidence is rising at 1% due to increases In Africa and E. Europe World exc Afr EEur Africa - high HIV 400 300 Africa - low HIV 200 Estimated TB incidence/100K/yr World E Europe 100 0 1990 1995 2000 2005

12. XDR-TB – extensive drug resistance XDR = MDR-TB plus resistance to at least 3 of the 6 available classes of second line drugs Of 17,690 isolates from 49 countries during 2000-2004 20% were MDR and 2% were XDR XDR found in: USA: 4% of MDR Latvia: 19% of MDR S Korea: 15% of MDR XDR found in Southern Africa associated with HIV

13. XDR-TB IN SOUTH AFRICA

14. Immediate • Conduct survey to determine geographical prevalence • Drug availability – PAS, Capreomycin • Training of clinicians • Dissemination of guidelines in both public and private

15. Infection control • Address infrastructural problems • Triaging of patients in OPD and wards • Surveillance • Contact tracing • Increase access to microscopy services • Communication strategy • GCIS to source provider

16. Review current location of M(X)DR TB hospitals and their internal accommodation arrangements

17. Thank you