South Africa is experiencing a rapidly increasing disease burden. The average life expectancy at birth remains low at 55,3 years for males and 60,4 years for females. This is largely due to an 11 % HIV prevalence rate; there is a high burden of tuberculosis with an estimated incidence of 970 per 100,000 population. Although there is no national data on the trend, there is evidence of an increase in the prevalence of diabetes among urban Africans. The prevalence of diabetes is estimated to be 5,5 % among South Africans aged 30 years and older.Diabetes is the seventh most common cause of death in the country and the numbers are increasing rapidly: after HIV, diabetes contributed to the highest increase in the number of deaths between 2004 and 2005. Treatment coverage is low, with 60 % of diabetes cases undiagnosed. Although all racial groups are affected, those most at risk are the blacks undergoing rapid lifestyle and socioeconomic transition, and people of Indian origin who have a higher propensity for diabetes.According to a Medical Research Council report, the total number of people with diabetes is going to increase with or without the expected impact of HIV/AIDS. The rise in HIV is associated with rise in TB incidence in South Africa. Co-infection with TB and HIV/AIDS is high, with an estimated 73 % of new TB patients co-infected with HIV. South Africa is ranked fifth of the 22 high burden TB countries with an estimated incidence rate of 948 cases per 100,000 population. Unless effective TB control is achieved quickly, South Africa will have 3,5 million new cases of TB and at least 90,000 TB related deaths over the next decade.The aim of this project is to reduce mortality and morbidity in persons with diabetes by improving prevention, early case detection and quality of care for persons with diabetes and TB.
Similar to other developing countries, the previous disease pattern in South Africa has influenced the health system to deal with acute and curable diseases. The increase in the prevalence of diabetes in South Africa has been superimposed on a health system that is carrying the burden of communicable diseases, particularly HIV and TB. Most health systems address diabetes and TB as vertical service delivery programs separate from each other in spite of clear interaction between the two diseases. University Research South Africa (URSA) has worked in the province of KwaZulu Natal since 2000 through projects addressing various programs related to HIV and has worked on integrating the two national vertical programs related to HIV and TB by providing technical assistance to provincial and district HIV and TB stakeholders. Using this knowledge, experience and network URSA will try to integrate diabetes screening, monitoring and treatment into ongoing TB activities at public and private health care in KwaZulu Natal province.To achieve the objectives the project will in collaboration with experts develop protocols for screening, counselling, and managing TB and diabetes, as well as establishing service linkage between diabetes and TB facilities. Training will be provided to strengthen capacity in diagnosis of diabetes and TB cases, and case management. The implementation of the new protocols will improve health care providers’ awareness of the association between diabetes and TB and compliance with screening techniques to identify TB suspects and detect diabetes among their patients. This will integrate systematic diabetes screening into initial services for people newly diagnosed with TB and during TB treatment, as well as TB screening into routine diabetes care services.The project will also provide supportive supervision for clinical quality improvement among health care providers and conduct quarterly patient review meetings to improve quality of diabetes-TB services. Finally, the project will conduct a baseline assessment to identify key gaps and opportunities for improving delivery of diabetes-TB best practices. A final conference will be held at the end of the project for provincial and national diabetes-TB stakeholders to discuss lessons learned, highlight best practices and to advocate for the inclusion of diabetes-TB in national policies, plans and reporting systems across country.
• 14 clinics strengthened with TB-DM care• 28 doctors, 66 nurses and 528 paramedics trained in TB-DM screening and care• Comorbidity counselling, screening and management protocols have been developed• 2,733 people with diabetes who are TB suspects have been screened for TB; 13 patients with diabetes treated with TB• 1,704 people with TB have been screened for diabetes; 21 patients with TB treated for diabetes