‘90-90-90’ strategy to improve on TB programme

The department of health has embarked on the 90-90-90 strategy, which is the global health initiative to improve its TB programme by 2020, and at the latest by 2025.

This strategy concentrates on “reach and quality”, with provincial health spokesperson Yonela Dekeda saying that the “first 90” is mainly focused on reaching 90% of all people with TB.

“Some people get sick with TB; however, do not go for testing to confirm if they have TB. They remain undiagnosed and cannot be treated.

“Screening of at least 90% of the facility headcount will help identify people with TB symptoms, and they will then be [checked] for TB,” Dekeda said.

She said the department also conducted active TB screening, with outreach teams doing screening in communities and especially of contacts of the person who has infectious TB disease.

“Digital chest X-rays are also used to screen people. In the Eastern Cape these are implemented in OR Tambo, the Buffalo City and Nelson Mandela Bay metros, and Sarah Baartman, in partnership with [nongovernmental organisations] Aquity Innovation and MatCH.

“Following the TB screen, people with symptoms are tested for TB using geneXpert tests, and the results are quick.

“This machine also detects resistance to one of the TB drugs called rifampicin, ensuring that TB patients can be put on appropriate treatment right away.

“The department, in partnership with National Health Laboratory services, started the initiative of sending the results directly to the patients to quicken receipt of the results. People are urged to produce sputum when asked to do so.

“According to performance from 2019/2020 to 2021/2022, the Eastern Cape has reached the ‘first 90%’ and is striving for 95%, as it is expected that targets will be changed to 95-9595.

“However, the challenge facing this ‘90’ is that some patients come to health facilities very late, when the spread has already occurred,” Dekeda said.

The “second 90”, Dekeda said, focused on initiating treatment to at least 90% of people diagnosed of TB within two to five days to control the spread of the disease.

“Availability and access to treatment has improved within the department, as all facilities provide susceptible TB treatment. “For multidrug resistant TB there are decentralised sites in all subdistricts to fast-track treatment initiation and continued care.”

She said prompt treatment initiation is crucial to improve health status of the patient and prevent the spread to other family or community members at large.

“By improving the rates at which people are diagnosed and treated, countries can reduce the spread of TB and drive down incidence.

“The Eastern Cape department of health has achieved the ‘second 90’ too; as such the target is now increased to 94% for 2023, which is closer 95% which will soon be implemented.

“However, the challenge of people failing to visit the clinics for treatment initiation makes it difficult to control TB, as untreated people continue to spread the disease,” Dekeda said.

The main focus of the “third 90” is to achieve at least 90% treatment success for all people diagnosed with TB through affordable treatment services.

To achieve desired outcomes, it is necessary to provide not only treatment, but adherence and social support too.

The “third 90” aims to ensure the quality treatment, support and follow-up needed to achieve at least a 90% treatment success rate among people identified as needing treatment.

“Once a patient is started on treatment, follow-up visits are needed to assess their clinical progress while on treatment, and for laboratory tests which are conducted on the seventh week and 23rd week,” Dekeda said.

“Visiting the clinic also gives the health provider the opportunity to provide health education on TB disease and treatment adherence.

This “third 90” has not been achieved by the department. While the target is 90%, the Eastern Cape has set the target at 77%, looking at the baseline.

“The Eastern Cape performance is ranging at between 75 and 78%.

“Some patients stop treatment when feeling better; others cannot continue collecting medication due to finance or work related factors.

“What is worsening the situation is that some patients do not provide correct contact details when registering at the clinics, making it difficult to do follow-ups.”