While tuberculosis (TB) is the top killer of people living with HIV, TB is also harder to diagnose in people living with HIV than in people who are not. What is more, TB is particularly difficult to diagnose in people living with HIV who have compromised immune systems.

South Africa’s TB testing numbers have recovered from dramatic COVID-19-related declines in 2020, delegates heard at the opening of the 7^th South African TB Conference, held on 13-16 September 2022 in Durban under the theme 'Working together to get TB control back on track'.

Tuberculosis (TB) is hard to diagnose in children, especially very young ones. This is because it is difficult for children to cough up the sputum required to perform the gold standard molecular TB test. Even if they do manage to cough up sputum, there may not be enough TB bacteria in it for a positive diagnosis since children’s sputum harbours fewer bugs than that of adults.

Under a new TB diagnosis strategy, people considered to be at high risk of TB are offered molecular TB tests, even if they do not have any symptoms. A landmark study in 2020 showed that such a strategy can help diagnose more people more quickly. Now, early indications are that it also works in the real world and South Africa’s lab service says they can cope with the increased demand.

The World Health Organization (WHO) estimates that every year 40% of people who fall ill with tuberculosis (TB) globally are not diagnosed. There is thus an urgent need for faster, safe, and more convenient TB tests. The current gold standard of testing still requires people to cough up sputum, something that some people and children, in particular, struggle with. The coughing up of sputum also poses an infection risk to healthcare workers collecting sputum samples.

One of the most intriguing findings from South Africa’s first National TB Prevalence Survey was that out of 234 people found to have TB, 58% had abnormal chest X-rays without experiencing any TB symptoms. The short report in which the findings were made public recommended the expanded use of X-ray technology for TB screening.

The COVID-19 pandemic hit South Africa’s TB response early and hard. To mitigate the impact of COVID-19 on TB, South Africa urgently needs to release the national TB Recovery Plan and the Department of Health should urgently implement steps outlined in the TB Recovery Plan to save lives.

Tuberculosis preventive therapy is highly effective in preventing TB disease and death, yet only a few people have access to it. Tiyese Jeranji reports in Spotlight on how Médecins Sans Frontières in Khayelitsha (Cape Town, South Africa) is helping TB patients and their contacts access preventive therapy in the comfort of their homes as part of a new family-centred care initiative.

South Africa’s First National TB Prevalence Survey (findings of which were published earlier this year) found that in 2018, the country’s tuberculosis burden was substantially higher than previously thought. 

Treatment of drug-resistant forms of tuberculosis (DR-TB) in South Africa has been transformed over the last decade. Most people with DR-TB no longer have to take daily injections and treatment is often completed in nine months, compared to 18 to 24 months in the past. Maybe most importantly, fewer people are dying of DR-TB and fewer people are suffering hearing loss, a common side effect of injections used in the past.