Johannesburg, South Africa, As the world observes World TB Day this year, AIDS Healthcare Foundation South Africa (AHF) is sounding the alarm on tuberculosis (TB), which remains South Africa’s leading cause of death.

Despite progress in diagnosis and treatment, TB continues to claim thousands of lives each year – more than HIV and Malaria combined. AHF is calling for urgent and coordinated action to accelerate TB prevention, improve diagnosis and treatment, and strengthen the country’s response to drug-resistant TB (DR-TB).

Globally, TB claimed 1.25 million lives in 2023, according to the World Health Organization (WHO). Multidrug-resistant TB (MDR-TB) remains a serious public health crisis, with only two in five people receiving treatment for drug-resistant TB in 2023. Nearly 11 million people fell ill with TB last year, with more than 80% of cases and deaths occurring in low- and middle-income countries like South Africa. While the global incidence of TB is declining, progress is far too slow and inconsistent to meet international targets. An estimated $22 billion is needed annually to end TB (World Health Organization) if we are to end TB by 2027 – less than 48 months from now, yet global funding continues to fall short, prompting a need to address governments on innovative funding models to strengthen Domestic Resource Mobilization.

Relying only on existing health financing models without exploring innovative health financing solutions undermines South Africa’s ability to sustain an effective TB response. Addressing TB requires significant investment from national health budgets, which are already under strain. Yet, opportunities such as public-private partnerships (PPPs) remain underutilized in the health sector.

"Public-private partnerships are a vital tool for health financing because they leverage private sector resources, expertise, and efficiencies to complement government efforts, expanding access to services and improving health outcomes," explains Ngaa Murombedzi, Regional Advocacy and Policy Manager (Southern Africa) at AHF.

“A comprehensive, bottom-up, multi-sectoral approach to Domestic Resource Mobilization is essential. This means engaging a broad range of stakeholders—including government, private sector, civil society, and communities—to increase health spending, particularly for TB and HIV, while ensuring other health priorities are not neglected. Other innovative financing mechanisms, such as health taxes, social impact bonds, and blended financing models, should also be explored to close funding gaps and strengthen South Africa’s overall health system.” Adds Murombedzi.

In South Africa, TB remains a national health emergency. The country reports an estimated 280,000 new TB cases each year. The burden is particularly high in densely populated areas such as eThekwini and Gauteng’s metros, which account for nearly 40% of national TB notifications. People living with HIV (PLHIV) are disproportionately affected, with TB-related deaths remaining high in this group. Childhood TB is also significantly underdiagnosed. In KwaZulu-Natal, only 6.7% of TB cases were identified in children, far below the WHO’s target of 15–20%.

“The intersection of TB and HIV is a major concern,” says Dr. Siyathemba Nxele, Provincial Medical Manager for AHF South Africa in KwaZulu-Natal. “Up to 70% of TB patients are also HIV-positive. However, TB diagnosis in HIV-positive patients remains a challenge due to limitations in current testing methods.”

Strengthening Early Detection and Diagnosis

Early diagnosis is key to stopping the spread of TB. While South Africa has expanded the use of molecular diagnostic tools like the GeneXpert MTB/RIF test, more than 65,000 TB cases were missed in 2022—many among young people aged 15–24 and adults over 65. “Despite having advanced technologies, TB screening and diagnostic protocols are not fully applied at primary healthcare level,” says Dr. Maxime Molisho, Provincial Medical Manager for AHF Mpumalanga. “We need to ensure that clinicians are properly trained to use tools like chest X-rays with computer-aided detection (CAD), urine LAM testing, and effective referral systems.”

AHF is addressing these gaps by deploying clinicians to its supported facilities and providing ongoing training on TB screening, diagnosis, and clinical management. “Patients with late-stage HIV are screened early for TB to ensure timely diagnosis and care,” says Mmatsie Tsotetsi, Advocacy Manager at AHF South Africa.

Tackling Drug-Resistant TB

In 2022, South Africa reported approximately 11,000 DR-TB cases, with more than 6,700 confirmed as MDR-TB. Poor treatment adherence, interruptions in medication, and incorrect dosing are contributing factors.

The WHO’s updated guidelines offer hope. The shorter six-to-nine-month BPaLM treatment regimen—combining bedaquiline, pretomanid, linezolid, and moxifloxacin—has improved treatment success rates to over 60%. However, challenges remain in ensuring patients complete their treatment. “Through telephonic follow-ups, food support for eligible patients, and partnerships with community organizations, AHF is working hard to reduce treatment drop-outs and improve outcomes for DR-TB patients,” adds Dr. Nxele.

Closing the Funding Gap and Policy Gaps

At the United Nations High-Level Meeting (UN HLM) on TB in 2023, world leaders committed to ending TB by 2030, with pledges to increase investments in TB services, develop new tools for prevention and treatment, and promote human rights-based approaches to care. AHF is urging South Africa to meet these commitments by closing funding gaps, expanding community-based services, and prioritizing prevention and early treatment.

Despite TB’s devastating impact, it remains underfunded in South Africa compared to HIV and COVID-19. The National Strategic Plan (NSP) for HIV, TB, and STIs (2023–2028) identifies TB elimination as a priority, but more resources are needed, particularly for preventive therapy, childhood TB diagnosis, and community outreach.

“Lessons from the HIV response—such as self-testing and contact tracing—can be adapted to strengthen TB care,” says Dr. Molisho. “AHF is supporting government efforts through clinical mentorship and program monitoring to ensure TB policies are implemented effectively.”

A Comprehensive Approach to TB Care

AHF continues to prioritise integrated HIV/TB care across its clinics. TB prevention, screening, and treatment are essential components of AHF’s global healthcare programs. AHF also advocates for policies that make TB drugs and diagnostic tools more accessible and affordable, while actively engaging communities and governments in the fight against TB.

In KwaZulu-Natal, AHF supports the “Stop TB in Children” campaign, aimed at increasing TB screening among school-going children and those outside the education system. In Gauteng, the focus is on addressing the social determinants of health, such as nutrition, access to social services, and identity documentation, through partnerships with departments like Social Development, SASSA, and Home Affairs. “We must take collective responsibility,” says Dr. Kgomotso Thipe, AHF Gauteng Provincial Medical Manager. “TB is airborne, highly infectious, and preventable—but only if we act decisively. Early detection, community awareness, and breaking the stigma are critical to saving lives.”

The Time to Act is Now

AHF echoes the WHO’s global message: “Yes! We Can End TB”.  With increased awareness, strengthened screening efforts, investment, and a commitment to scale up prevention and treatment, South Africa can take meaningful steps to end TB once and for all.

“TB is still the number one killer in South Africa,” concludes Dr. Molisho. “We must act now to protect our communities and future generations.”