Washington Post talks about TB in India, but not in South Africa

The Washington Post’s Simon Denyer wrote a very important article about India’s great effort to treat and control tuberculosis, in the face of a growing threat of drug-resistant strains of the disease. The article was paired with a graph of TB incidence over the past 20 years. India, which is highlighted on the graph, has clearly done quite well against major odds–poverty, inequality, poor infrastructure. It has decreased TB incidence by 14% over 20 years, mandated case notifications and for all of this deserves praise, case studies and much more.

The article mistakenly fails to mention the outlier in the graph–South Africa’s TB incidence has increased by over 200% over the same 20 year period, while all other countries in the graph, including the “global trend line”, have decreased.

The confounding factor is HIV. While South Africa’s TB control program benefited from the introduction of directly observed treatment short course (DOTS) in the 1990s, the same way India’s did, South Africa’s growing HIV epidemic muted these gains and led to a sharp rise in TB case notifications. South Africa now faces a 70% HIV/TB co-infection rate (Karim et al. 2009) and TB is the leading cause of death among people living with AIDS.

This graph highlights the need to address TB and HIV concurrently and with an integrated response. Check out the recently released National Strategic Plan on HIV, STIs and TB for 2012 – 2016 to learn a bit more about how South Africa is addressing its HIV and TB epidemics.