Minister of Health

1. Public-facing TB Dashboard

The WC Public TB Dashboard had the following aims during development:

1. 1. Inform citizens about Tuberculosis on a timely basis and granular level across the WC
   2. Build trust by being completely transparent
   3. Ensure safety of patient data
   4. Ensure public accountability of the status of the TB epidemic

The dashboard has been running successfully since the official launch in September 2021, having had achieved all four aims as set out above. The dashboard gets updated monthly and publishes are timestamped as new data becomes available.

All data is available to a subdistrict level and can be filtered and sliced as required. Safety of patient data has been paramount throughout development and the team has ensured that no identifiable characteristics can be garnered from it, whilst still ensuring its relative utility. Lastly, the health department is a large organization, and the dashboard has allowed for both public and internal provincial health accountability.

Many clinicians within our hospitals have engaged with and can follow the impact of TB within their working context. It is a slow process to turn the tide, to improve targeted testing and to tackle the inherent challenges that come with TB but taking the first step in making the issue visible and clear, we believe, is a step in the right direction.

The dashboard can be accessed at:

Provincial TB Dashboard | Western Cape Government

2. Communication campaign including WTB Day activities 2022 (TB Dashboard, Symposium and Delft

A fully fledged public communication campaign to highlight the need for enhanced TB testing as

for COVID-19 - propose a Test & Treat (TPT and active TB disease treatment) Campaign

• Include personal stories, including those of survivors
• Focus on personal responsibility for prevention – being part of the solution
• Promote positive messaging – collective responsibility, TB can be beaten, etc.

Key Message: Getting back on track and doing more

3. USAID Support

USAID has expressed its intent to fund support for TB-specific interventions through an investment of US$ 550 000 over a two-year period.

The Provincial TB Emergency Response Plan was used as the guiding document to establish priority interventions for the funding.   A TB task team (comprising of provincial, district and municipal health representatives) was formed to determine recommendations for the funded support. A subsequent workshop was held in September to showcase best practices and models relating to contact tracing and TB screening and testing implemented by NPO partners across the Province. The workshop was attended by representatives of the listed organizations, USAID, WCG and City Health representatives

The following recommendations were made for support through the TB G2G funding:

1. To conduct a Province-wide workshop of the TB Emergency Response Plan with districts and partners.
2. To introduce innovations such as folder prompts for TB screening and TPT initiation.
3. To optimize the use of the public-facing TB dashboard and to demonstrate the functionalities of the dashboard so that it can be used as a tool for data visualization.
4. To develop guidance on the launch of the TB screening app and its functionalities. To develop guidance on:
   • processes to follow when clients screen positive through the app
   • access to app screening data to ensure optimal follow up and linkage to care
5. To develop guidelines for health care workers conducting community-based TB screening.
6. To develop guidelines for healthcare workers on screening of household contacts and linking of clients to care for further interventions such as provision of TPT.

Progress and Way Forward TB G2G funding:

1. Provincial Support team for TB has been identified
2. Discussions underway on:
   1. Integrating TB within the late life course
   2. Milestones and activities for the TBG2G defined and awaiting final approval
   3. Workplan developed and awaiting approval

3. Implementation of Urine LAM

Training for healthcare workers on the implementation of Urine LAM Testing has commenced.  The training curriculum covers the following:

• • The impact of HIV on the clinical course of TB.
  • Challenges related to diagnosis of TB in people living with HIV (PLHIV).
  • LAM and LAM test.
  • WHO recommendations on LF-LAM.
  • Revised criteria on the use of LF-LAM in South Africa.
  • Requirements for the test and test procedure.
  • Results and interpretation.
  • Acting on the results.
  • Monitoring and evaluation.
  • Advantages and limitations of the test.
  • Roles and responsibilities.
  • Quality control and storage requirements.

The Circular H 191 of 2021on Urine LAM testing went out at the end of November 2021 for implementation on 1 December 2021.

TB Preventative Therapy (TPT)

3HP is a shorter treatment regimen (3 months) and consists of combination of Rifapentine and INH as opposed to INH only which needs to be administered over a period of 12-month period which has had a poor completion rate. There is insufficient stock to implement in the whole country, so the Metro has been identified has the high burden district to implement the new regimen.

The Implementation of 3HP has been tabled at Opexco for approval and was presented on 8^th March. Managers requested an additional time to review the submission. A final decision will be provided by the end of March. This was communicated to the NDOH.

Targeted universal TB Testing for high-risk groups

(PLHIV, TB contacts, people with previous TB – less

than 2 years)

TBHC has indicated that GF will fund all GeneXpert tests in the Cape Metro once TUTT is implemented, even though TUTT implementation will be restricted to TBHC- supported sites. SPC will be meeting with NDOH on 7 April to clarify the details of the policy framework of the TUTT intervention, and the funding mechanism for GXP testing.

Digital CXR

DCXR has been piloted by TBHIV Care at 3 sites on the province (Metro).  The districts still to decide on additional pilot sites for further rolled out. TBHC has recently introduced a mobile DCXR truck, which will target TB case finding in GIS-identified TB Hotspots.

Self- screening APP

The self-screening app has been incorporated into the TB Dashboard.

Telehealth

As part of the response plan, the department is also planning on launching a TB telehealth initiative that will improve linkage to care of patients newly diagnosed with TB.

Joint Screening and testing for COVID and TB

Joint screening and testing has been incorporated into PACK

which is implemented across the Western Cape

Enhanced Advocacy for psychosocial and nutritional support for people living with TB

Psychosocial Support

TBHIV Care supports with adherence counselling, treatment readiness counselling, psychosocial and psychological support as well as socio economic support (referral for disability grants, ID documents, substance use interventions)

Nutritional Support

Clients infected with TB is one of the identified nutritionally at-risk groups included on the Nutrition Therapeutic Programme for a minimum period of 6 months.  

These clients are identified using anthropometric assessments in the evaluation process and offered nutrition supplements to help improve treatment adherence and success, delay progression of the disease and to help improve their nutritional status.  Clients requiring additional support are referred to a Dietitian for further nutritional management towards improved outcomes.

World TB Day

Global and National Theme for WTB Day 2022:

This year the Global WTB Day Theme is:  Invest to End TB. Save Lives. 

The National WTB Day Theme is:  Invest in action to END TB now!  Get Screened.  End Sigma.  Save lives.

WTB Day events 2022:

Several World Tuberculosis (TB) Day events are commemorated across the Western Cape by the Department of Health, its partners and civil society. At the provincial event, the Western Cape Minister of Health Dr Nomafrench Mbombo officially launched the first mobile Digital Chest X-ray van at Delft CHC which will be used to target high TB burden areas.