The Health Portfolio Committee was delighted to receive feedback that the City, in partnership with the Provincial Department of Health (Metro District Health Services) and TB/HIV Care Association has received a United Nations award for the fight against Tuberculosis (TB), but at the same time noted that there is still room for improvement in fighting the disease.

The partnership received the award for its creative response to two different problems affecting poor communities in Cape Town. The first problem is that the incidence of TB has been rising consistently over the last 10 years while cure rates have remained static. This is partly because patients fail to complete the lengthy treatment or their response to treatment is not adequately documented due to the intense pressure that nursing staff work under.

The second problem, though not directly a health issue, is the question of unemployment, especially for recently matriculated learners who are unable to find a foothold in the formal economy.

In response to these problems, City, Provincial and TB/HIV Care Association health officials came up with the idea of employing unemployed school leavers as TB Assistants and TB Clerks to monitor and record TB treatment schedules.

The project passed two rounds of selections for the UN award and the City was informed in May last year that it had been selected as a finalist for the award of Improving the Delivery of Services. Partners of the project were requested to send a representative to the awards ceremony which was held in June last year.

Over 400 participants, including the Secretary-General of the United Nations, Ban Ki-Moon and the Deputy Secretary-General for Economic and Social Affairs, Sha Zukang, attended the ceremony at the UN Headquarters in New York. A representative of the Western Cape Department of Health received the award on behalf of all three partners.

Councillor James Vos, Chairperson of the Health Portfolio Committee, said he was very proud of the achievement, but stressed that the hard work needs to be maintained and that there is room for improvement. “We aimed to work with the Provincial Health Department and TB/HIV Care Association to mainstream a multi-sectoral response that mobilises all City sectors to fight HIV/Aids and TB, thereby reducing the number of new HIV infections, especially among the youth, and also reduce transmission of TB in our communities.”

Vos added that in the view of the multiple factors contributing to both pandemics and the sheer scope and impact of these, it is clear that turning the tide of HIV/Aids and TB requires the involvement of all sectors. “Our aim is to reduce the impact of HIV/Aids on individuals, families and communities, including the City’s workforce, and reach an 85% cure rate for new smear positive TB cases.”

Cape Town has an extremely high number of TB cases with 28 956 reported cases in 2009 and an incidence rate of 877 per 100 000 (compared with a national figure of about 500 per 100 000).

Factors that fuel TB in Cape Town include:

• Poverty 
  
• Urbanisation with resultant overcrowding 
  
• Damp, poorly ventilated houses/shacks 
  
• High HIV prevalence 
  
• Clients presenting or being identified late in the course of the disease (which means that they infect many others before treatment) 
  
• Poor treatment outcomes due to treatment interruption (defaulters) 
  
• Substance abuse 
  
• Smoking

Despite Cape Town’s extremely high TB rate, the City has managed to achieve the best cure rate for the disease (almost 80%) compared to other metros in the country last year. There is a high co-infection rate with HIV, so integration with HIV care is important.

The City’s TB targets for 2009/2010 are:

• New smear positive TB cure rate per quarter: 78% 
  
• Slow the rate of increase of TB per 100 000 of Cape Town population: ≤1090 
  
• % TB patients tested for HIV: 90% 
  
• % HIV-positive TB patients who have a CD4 count: 95%