Close collaboration between researchers and community groups has been key to South Africa more than halving the incidence of tuberculosis (TB) in the past decade, according to researchers and community activists.

Women researchers and advocates have been at the heart of the country’s fight against TB, and several South African scientists have also led global TB research breakthroughs, according to presenters at a webinar on Thursday, co-hosted by Global Health Strategies, Bhekisisa and Health Policy Watch.

But the sudden and substantial loss of donor funding this year may translate into 580,000 fewer people being tested for TB and 35,000 fewer getting TB treatment this year, according to researchers writing in the International Journal of TB and Lung Disease (ITLD).

The country lost $34 million overnight from the US Agency for International Development (USAID) and US President’s Emergency Plan for AIDS Relief (PEPFAR) – $12 million for TB prevention, $5 million for screening, $10 for testing and $7 million for treatment.

This cut could have a dire impact on the figt against tuberculosis, which kills over 56,000 South Africans daily.

Interdisciplinary collaboration

Professor Valerie Mizrahi, a leading TB researcher for over three decades, says that South Africans have made “massive contributions” to the global TB fight because of “a high degree of integration, collaboration and coordination”.

“We are a community of people who work together to tackle the disease in an interdisciplinary way,” Mizrahi told the webinar.

Basic scientists, clinical researchers and public health specialists collaborate with civil society advocates, community engagement experts, and government “with a unified vision of what we’re trying to achieve,” said Mizhari, who recently retired as director of the Institute of Infectious Disease and Molecular Medicine at the University of Cape Town. 

“At the core of this integrated enterprise are women.”

“South Africa has a fantastic TB programme,”  Prof Lee Fairlie told the webinar, detailing how advances in TB diagnosis and treatment, including new and shorter regimens for multi-drug resistant TB, had been pioneered in the country.

New TB vaccines are in late-phase trials, while researcher Anura David, from Wits University’s Diagnostic Innovation Hub, is currently working on a TB self-test based on an oral swab to deliver faster, easier results.

But the funding cuts have “severely affected” TB research, said Fairlie, who needs to “work hand-in-glove with communities” when recruiting people for these TB studies.

Resources for data collection and monitoring and evaluation have been hard hit.

Certain programmes – such as those aimed at men who have sex with men and transgender people – have disappeared completely, said Fairlie, director at maternal and child health at the Reproductive Health Institute (RHI) at Wits University in Johannesburg.

Some 15,000 frontline staff and 9,000 technical staff have lost their jobs, according to the TB Accountability Consortium in a recent presentation to the South African Parliament.

“Many people have lost funding. Many people have had to be retrenched. And of course, this takes us a steps back from potential breakthroughs around optimal treatment for both HIV and TB,” said Fairlie.

She added that there is a real risk that “people are falling out of care, not having access to treatment, which if you’re living with HIV, obviously increases your risks of becoming diseased with TB”. 

Sibongile Tshabalala, chairperson of the Treatment Action Campaign (TAC), said a recent survey of around 8,000 patients at 300 clinics found TB testing has dropped and that waiting times have increased since posts for health workers and testing facilities have been eliminated. Only half of those surveyed 

The TAC’s education campaigns on TB and HIV have also been affected.

Appeal to the government

Before the funding cuts, the South African government launched its “End TB” campaign, which aims to test five million people for the bacteria by the end of next year. 

But the TB Accountability Consortium points out that there is only funding for three million TB tests, and describes the health budget as “chronically underfunded”.

Half the world’s funding for TB research and development comes from only two sources: the Gates Foundation and the US National Institutes for Health (NIH), which has changed its funding priorities since the Trump administration assumed power, said Mizhari.

“This is forcing us to look inward as African countries and to actually take our seat at the table of responsibility for looking after this field,” said Mizhari.

She warned that the South African TB sector is going to be “severely tested in the near term”, and the only way in it can unlock the necessary funds from donors and funders is to “make a very, very powerful case for the value proposition for tuberculosis, and I think that we’ve all got to think very deeply about what that is going to entail in a resource limited setting where there are so many other competing priorities.”

Time to prioritise

“We cannot sit back and just accept that this is the way things are going to be,” Mizhari urged. “We need to look at what our priorities are. We need to find much better ways to share information, to avoid duplication, and to double down on what it is that we need to do. There is no public health problem that is more severe and serious than TB.”

Tshabalala urged the private sector to invest in TB, particularly urging large employers to step in.

Meanwhile, Fairlie pointed out that researchers are “entirely dependent on donor funding”, and called for “increased collaboration across the spectrum” to ensure that “important work remains funded”.

This article is based on a webinar co-sponsored by Health Policy Watch, Global Health Strategies and Bhekisisa. 

Image Credits: TB Alliance, USAID, Southern Africa/Flickr.