SOUTH AFRICA PUBLIC HEALTH April 7 2006 ISSUE

UNCLAS SECTION 01 OF 04 PRETORIA 001415

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E.O. 12958: N/A
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT: SOUTH AFRICA PUBLIC HEALTH April 7 2006 ISSUE

Summary
--------------


1. Summary. Every two weeks, Embassy Pretoria publishes a
public health newsletter highlighting South African health
issues based on press reports and studies of South African
researchers. Comments and analysis do not necessarily reflect
the opinion of the U.S. Government. Topics of this week's
newsletter cover: Focus on South Africa and TB; SA's TB Cure
Rate Still Poor; TB Crisis Plan Targets Four Districts; Western
Cape's High Cure Rate; Zambia and South Africa Tests
Effectiveness of Community Public Health Interventions; HIV
Education in Prisons; Finland and South Africa Collaboration in
Aids Research; South Africa's Avian Flu Contingency Plan; South
African Development of AIDS Vaccines; SA Prevents TAC from
Attending UN AIDS Session; and TAC Plans to Attend UN Session.
End Summary.

Focus on South Africa and TB
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2. March 24 was International TB Day and the following
articles present South African statistics and research on the
disease. World Health Organization data shows South Africa
having the third highest overall TB prevalence in the continent
after Nigeria and Ethiopia and the fifth highest number of new
TB cases in 2004 globally just after India, China, Indonesia
and Nigeria.

SA's TB Cure Rate Still Poor
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3. Little more than half of all tuberculosis patients are
cured in South Africa, multi-drug resistant TB is increasing,
and yet new drug regimens may provide optimism on increasing
South Africa's TB cure rate of 54%. In 2003, approximately
185,000 new TB cases were diagnosed in South Africa, rising by
94,000 cases in a single year, with 279,000 new TB cases in

2004. South Africa's cure rate falls short of the World Health
Organization's goal of 85%. South Africa has the eighth
highest TB burden in the world and deaths from untreated TB are
high. Dr Lindiwe Mvusi, the Health Department's National TB
Manager, believes that the increase in cases shows that people
are reporting to clinics at an earlier stage of their TB
infection. Multi-drug resistant (MDR) TB is an increasing
problem, which does not respond to the usual six-month regimen
of ordinary TB drugs and needs more expensive drugs that are
taken for about 18 months. Usually only half of MDR TB
patients are cured. Mvusi said that 1.6% of new TB cases are
MDR TB while 6.7% of patients who are being retreated for TB
are diagnosed as having MDR-TB. HIV is also adding to the TB
burden, with a high proportion of people with TB also being co-
infected with HIV. Professor Valerie Mizrahi, co-Director of
the Center for Excellence for Bio-medical TB Research at the
National Health Laboratory Service points to recent
improvements in TB drug development as reasons for hope. She
stated that there have been no new TB drugs for 40 years and
suddenly, over the last five to 10 years, new research in the
science underlying TB disease and the bacteria that causes TB,
there has been renewed interest in the field. South Africa is
participating in Phase 2 trials for new drugs and combinations
to treat TB, with major studies in Cape Town and Durban. The
Global Alliance for TB Drug Development thinks new TB drugs
will be available by 2010. Source: Health-e News, March 24.

TB Crisis Plan Targets Four Districts
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4. South Africa's TB crisis plan will focus initially on four
health districts with both poor TB cure rates and many TB
patients, namely eThekwini metro (Durban),Johannesburg, the
Nelson Mandela metro (Port Elizabeth) and Amatola district
(East London). The official start of the plan began at King
George V Hospital in eThekwini, the worst performing
metropolitan area in the country with over 24,000 new TB
patients in 2004, and a cure rate of less than one in three.
Health Minister Tshabalala-Msimang cited critical elements to
the success of the plan as adequate human and financial
resources, access to laboratory services, better TB reporting,
recording and referral of patients and a highly visible social
mobilization and media campaign. The Minister played down the

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link between TB and HIV, despite consensus among medical
experts that HIV is driving the TB epidemic. While the crisis
plan includes joint HIV and TB measures, Tshabalala-Msimang
said that making the link between the two epidemics could mean
that patients were double stigmatized. Multi-drug resistant TB
is a serious problem. While TB cost between R400 ($67, using 6
rands per dollar) and R600 ($100) for a six month treatment, it
cost R24,000 ($400) to treat someone with MDR TB. Doctors from
King George Hospital, which has one of the biggest MDR TB case
loads in the country, said there was little information about
how the MDR TB drugs interacted with antiretroviral drugs.
Source: Health e-News, March 24.

Western Cape's High Cure Rate
--------------


5. Two Western Cape health districts are recording in excess
of 80% TB cure rates. Dr. Keith Cloete, acting head of the
provincial health department, attributes this to patient
monitoring and committed staff. The Eden district which
includes Knysna, George, Plettenberg Bay, Oudtshoorn,
Riversdale and Beaufort West had 5,366 TB patients in 2004 and
recorded a cure rate of 81.8%. The Overberg district which
includes Caledon cured 84.5% of its 2,437 patients in 2004.
The Cape Town metropolitan area had 25,824 TB cases in 2004,
with a cure rate of 64.8%. Numbers in Cape Town have increased
significantly at clinics in areas such as Khayelitsha and
Nyanga where the TB epidemic is being fuelled by the HIV
epidemic. The Western Cape Province has increased funding to
the TB program which will be used to employ more staff, channel
more money to the non-governmental sector for treatment
supporters and increase capacity at the laboratories. Five sub-
districts will receive more funding in 2006: the Breede Valley
(Worcester),Drakenstein (Paarl),Eastern (Helderberg and
Oostenberg),Khayelitsha and Klipfontein (Old Nyanga and
Athlone). In 2005 Klipfontein had 3,769 TB cases and
Khayelitsha 5,640 with cure rates of 67.9% and 51.7%,
respectively. The Western Cape's TB cases have increased from
27,509 cases in 1997 to 47,603 in 2005. Source: SAPA, March
23; Health E-News, March 24.

Zambia and South Africa Test Effectiveness of Community Public
Health Interventions
-------------- --------------


6. Zamstar, the Zambia South Africa Tuberculosis and AIDS
Reduction Study, is trying to improve TB treatment by focusing
on public health interventions in 8 communities in the Western
Cape and 16 in Zambia. Clinic-based HIV and TB interventions
are a critical part of the study, with both TB and HIV services
working closely together. All TB patients will be tested for
HIV and all patients going for Voluntary Counseling and Testing
at the HIV Clinic will be referred for TB testing. At
community level, awareness will also be raised using simple
messages. In schools, Zamstar workers will be raising TB
awareness from grade one to 12, moving from school to school
and setting up sputum (mucus) collection points. Zamstar's aim
is to ensure that every person in the target communities will
be able to give a sputum sample at least three times a year to
a place which is within a 30 minute walk. Community health
workers will also be doing household interventions where TB has
been diagnosed. These homes will be viewed as being at risk of
HIV and TB. In 2009, prevalence studies will be done where
5,000 adults will be tested for TB, key to establish how many
people remained undiagnosed despite the interventions.


7. In South Africa, Nyanga, Phillipi, Khayelitsha Site C,
Harare, Wallacedene, Delft-South, Kayamandi and Mbekweni/Phola
Park will participate. A quality assurance team will travel
between South Africa and Zambia to monitor among others the
quality of the interventions as well as the laboratory
services. The South African study is run in close
collaboration with the Provincial TB Program and TB services in
the Cape Town metro. The community interventions, which will
last three years, start in April. It has already taken 18
months to get support from the community and establish a
community advisory board. Source: Health e-News, March 24.

HIV Education in Prisons
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8. A study by the South African Medical Research Council
points to success in education prevention interventions aimed
at sexually transmitted diseases for male South African
prisoners. Dr. Sibusiso Sifunda studied four prisons, two in
KwaZulu-Natal and two in Mpumalanga, and found that HIV
education programs with participation by former inmates led to
safer sex along with intentions to reduce risky behavior in
sexual encounters. According to Sifunda, appropriate education
would provide the prisoners critical life skills and would help
prevent additional infections of sexually-transmitted diseases.
Low prisoner education served as a major barrier to traditional
health education techniques, such as government-issued
leaflets. The study reported that most inmates will have sex
within the first few days of being released, risking increased
transmission. Source: Cape Argus, March 30.

Finland and South Africa Collaboration in AIDS Research
-------------- --------------


9. The Perinatal HIV Research Unit (PHRU) and FIT Biotech, a
Finnish biotechnology company, will collaborate to test the
safety of a vaccine that may control the progression of HIV to
AIDS. This is the first vaccine aimed at already infected
individuals and the clinical trial will determine the dosage as
well as the best way to administer the vaccine. According to
the clinical trial's principal investigator, Dr. Eftyhia
Vardas, clinical virologist at PHRU, the vaccine would keep the
viral load of infected individuals down, while increasing the
person's CD4 cells. According to the SA AIDS Vaccine
Initiative, phase-one safety studies on the vaccine were
completed in Finland and showed an excellent safety profile.
South African enrollment began at the end of March with
suitable candidates being HIV-positive, between the ages of 18
and 40, with a CD4 count greater than 400 and not on anti-
retroviral treatment. The target enrollment is 54 patients in
South Africa and another 6 in Finland. The phase 2 study would
last one year. Source: The Star, March 31.

South Africa's Avian Flu Contingency Plan
--------------


10. South Africa has started strict import controls and an
extensive surveillance program to prevent an outbreak of the
H5N1 avian flu. South Africa has yet to record a positive case
of avian flu among domestic or wild birds within its borders
and authorities want to ensure that this continues. The
contingency plans include: (1) banning the import of live
birds from any countries where the virus has been confirmed;
(2) quarantining and testing any birds imported from virus-free
countries; and (3) prohibiting the import of live pigs from
affected countries. Surveillance of wild birds, domesticated
ostriches, commercial and non-commercial chickens will be done
every 6 months in different areas. In the event of an
outbreak, immediate quarantine, culling and vaccination of
staff and labor in contact with infected birds will begin. A
Disease Control Center will coordinate the necessary actions to
handle the disease outbreak. The national Department of Health
has sent its preparedness plan to Cabinet for endorsement and
once endorsed, the plan will be public. Source: Pretoria
News, March 28.

South African Development of AIDS Vaccines
--------------


11. Dr. Glenda Gray, co-Director of the Perinatal HIV Research
Unit expects that a South African AIDS vaccine might be
available within four to five years. Two locally-developed
vaccines had already been tested for effectiveness in mice and
baboons and showed promising results. Gray hoped that human
trials would start in Africa and America in January or February

2007. South African research is concentrating on the sub-type
C HIV epidemic, accounting for 50% of global infections.
Research in Europe concentrated on sub-type B HIV. Gray
worries that so much research is concentrated on the vaccine
itself, without considering manufacturing or dispensation
problems that might block the most effective HIV/AIDS
treatment. Other South African medical analysts were not as
optimistic about the five year vaccine availability. Michelle
Galloway of the Medical Research Council agreed with Gray's
assessment of the quality of South African vaccine research,
yet sounded a cautionary note about the development speed,

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noting that the first and second phase typically takes two to
three years each while the third phase takes between three and
five years. She also stated that it took 20 to 30 years to
develop vaccines for other viruses, and HIV is more complex.
Source: City Press, April 2.

SA Prevents TAC from Attending UN AIDS Session
-------------- -


12. Due to objections from the national Department of Health,
the Treatment Action Campaign (TAC) and its affiliate, the AIDS
Law Project will not be able to attend the UN General
Assembly's special session on AIDS, scheduled for May 31 to
June 2. According to Thami Mseleku, the Director-General of
Health, the Department objected to TAC's presence because they
used previous global forums to vilify the government. He said
that the government would rather resolve its differences with
the TAC within the country. Mseleku said that this decision
had been made by the Health Department without consulting the
President's office. Source: Sunday Independent, April 2; The
Mercury, April 3.

TAC Plans to Attend UN Session
--------------


13. The Treatment Action Campaign (TAC) plans to attend the
late May UN session on AIDS by being included as
representatives of other non-governmental organizations if they
are not included in the South African government's official
country delegation. Mark Heywood, a member of the TAC
executive committee has stated that a number of already
accredited organizations have offered TAC places in their
delegations. The TAC and the Aids Law Project are two of six
organizations worldwide denied accreditation for participation.
Source: Pretoria News, April 6.

TEITELBAUM