Media statement

Comprehensive TB-HIV care programme gains momentum -‘THAT’S IT’ launches in Eastern & Western Cape

THAT'S IT  -  the comprehensive TB-HIV care programme that was launched two years ago to combat the dual epidemics more effectively, has gained momentum with the launch of two more sites in Matatiele on the border of the Eastern Cape and KwaZulu-Natal, and Bitou in the Western Cape. The programme now supports more than 100 clinics in four provinces and delivers care to some 35 000 affected people.

The programme represents a unique partnership between the South African Medical Research Council (MRC), the Foundation for Professional Development (FDP) and the Department of Health in the various Provinces and has built on the experience gained with its first two projects in Richmond, KwaZulu-Natal, and the Bophirima district of North West Province.

The THAT’S IT programme, an acronym for(Tuberculosis, HIV & AIDS Treatment Support and Integrated Therapy), is designed to ensure that patients suffering from TB and HIV receive a full range of services to effectively address both conditions. TB incidence is at an all-time high in South Africa. This year, half a million cases of TB cases are expected in South Africa. On average, 60% of TB patients are also co-infected with HIV, with a first-time reported cure rate not even reaching 60%,which poses a major risk to the development and spread of future drug resistance.

Dr. Karin Weyer the Director of the MRC’s TB Epidemiology and Intervention Research Unit says that “TB needs to be cured the first time round before it develops into MDR-TB and XDR-TB, which is prevalent in all nine provinces.   Spread of MDR-TB and XDR-TB to vulnerable population such as HIV-co-infected individuals can have devastating consequences - aside from a much reduced possibility of cure, HIV-infected patients who contract MDR-TB or XDR-TB may develop complications more easily and as a result the death rate is very high.”  

“Experts agree that strict infection control measures are critical, especially in HIV settings, to prevent outbreaks of TB and drug-resistant TB in vulnerable groups.   “We have focused on infection control as an important preventative measure at all THAT’S IT sites. At the Khotsong Hospital in Matatiele and in Bitou, for example, the facilities have been equipped with ultraviolet lights and extractor fans to ensure adequate air flow at all times, and patients sessions are staggered to avoid cross-infection,” says Dr Margot Uys, project manager of THAT’S IT.

TB services in South Africa are more often than not run in parallel to HIV services, which means that the dually-infected TB patient often has difficulty in getting appropriate HIV care.  In addition, persons with HIV infection are often not screened for TB, the most common opportunistic infection in co-infected individuals.  THAT’S IT represents a best-practice approach to a one-stop service for patients with TB and HIV co-infection.  TB patients receive comprehensive HIV services, including voluntary counselling and testing, prophylactic treatment to prevent other opportunistic infections, nutritional supplementation, and antiretroviral drugs (ARVs) should they need them.  TB patients without HIV are included in wellness programmes aimed at helping them to stay HIV-negative.  HIV-infected individuals are asked about TB signs and symptoms and referred for TB testing and treatment  at the earliest opportunity.      

The THAT’S IT project in the various provinces is run with funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR)  with the guidance and the expertise of the MRC and the FPD.  The project aims to provide comprehensive and integrated TB-HIV care in some of the most resource-limited and inaccessible areas in South Africa. 

“It has been our strategy to drive treatment projects from within the communities, with strong support from community leaders. We place emphasis on education and training and to destigmatise the diseases so that patients can retain their dignity. In future, we will have a ‘TB Walk’ for the community at all new launches to increase the visibility of our facilities and gain support for the programme,” says Dr Uys.

“As part of our approach, we have also deployed four mobile clinics that can easily reach remote areas to do preventative counselling, testing and deliver treatment,” she says.

Fact sheet 1
TB-HIV Facts

• South Africa faces one of the worst dual epidemics of TB and HIV in the world, being ranked 2nd in terms of TB incidence (number of cases per capita) and 5th in terms of overall TB burden.
• A person infected with TB has only a 10% lifetime risk of getting active disease because the immune system keeps the TB infection in check; however, if such a person becomes infected with HIV the risk for active TB increases to 10% per year because of immune suppression.
• HIV not only increases the number of TB cases, but also alters the clinical course of TB disease. TB becomes more difficult to diagnose and can rapidly become fatal if not quickly diagnosed and treated. 
• Policies for voluntary HIV counselling and testing of TB patients have been introduced in South Africa recently; however, uptake of these policies has been slow, given the stigma around TB and HIV still prevailing in many communities.
• Despite the fact that TB is curable (even when a patient is HIV-positive) many patients on TB treatment default from the 6-month regimen.  The DOTS strategy for TB control has been shown to be highly successful in many parts of the world; however, South Africa is lagging behind with cure rates of less than 60%.
• Prematurely stopping TB treatment leads to the development of multidrug-resistant TB (MDR-TB) and extensively drug resistant TB (XDR-TB), which is extremely expensive and difficult to treat.  Patients with MDR-TB, XDR-TB and HIV have a very high risk of dying.  The two multi-drug resistant forms of TB can also easily be spread to HIV-infected individuals.