A tale of two indicators
A story of the interplay between HIV and tuberculosis in South Africa and the hopes and challenges in the 21st century
Intersections
The Sustainable Development Goals have been developed to assist society in achieving a better and more sustainable future for all. In the context of global change, interactions between different factors are complex and interlinked.
This is also the case between SDG targets where success of a target can contribute to the success of another target (1) or negatively impact progress towards it (-1).
In many countries in sub-Saharan Africa TB and HIV present a co-epidemic such that progress towards one will significantly impact progress towards the other ( IFRC, 2020 ).
"The two diseases are a deadly combination; they are far more destructive together than either disease alone. In developing countries many people infected with HIV contract TB as the first sign of AIDS."
South Africans experience some of the highest rates of both TB and HIV in the world and the fate of progress towards eliminating TB is inextricably linked with progress towards eliminating HIV.
HIV and TB Global Case Numbers
Move the bar right for HIV data and left for TB data.
HIV
3.3.1 Number of new HIV infections per 1,000 uninfected population, by sex, age and key populations
Number of People Infected with HIV per Country
Since the start of the HIV pandemic:
- 75.7 million people have become infected
- 32.7 million people have died
- In 2019, 38.0 million people globally were living with HIV with the majority of cases in Sub-Saharan Africa
In South Africa alone over 7.5 million people are currently infected with HIV.
New HIV Cases per 1,000 people
In addition to having the highest number of cases, Sub-Saharan Africa also has the highest number of new cases.
South Africa currently has a rate of 4.94 new HIV infections per 1,000 uninfected people ( UNAIDS, 2018 ), one of the highest in the world.
While the new HIV infection rate for South Africans is significantly higher than the global average, the overall rate has been on a steady decline over the last 15years.
South Africa and the UNAIDS Targets
South Africa has adopted the UNAIDS program's 90-90-90 targets.
Target 1. TEST
Target 2. TREAT
Target 3. SUPPRESS
South Africa and the 90-90-90 Targets
South Africa, thus far, has met the first of the three UNAIDS 90-90-90 Targets - 90% of those infected with HIV know their status.
Of those, 67% are on antiretroviral treatment and of those 41% have suppressed viral loads ( UNAIDS, 2018 ).
Tuberculosis
3.3.2 Tuberculosis incidence per 100,000 population
Tuberculosis (TB) is one of the most infectious diseases known to man and signs and records of it can be found throughout history ( Barberis, 2017 ).
By the time HIV had come into play in South Africa, TB had long since been a scourge on the South African people.
By 2018, 24% of new cases globally were from the African region ( WHO, 2020 ).
In 2018, the 30 high TB burden countries accounted for 87% of new TB cases. Eight countries account for two thirds of the total, with India leading the count, followed by, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa.
Currently, South Africa has a TB incidence rate of 520 per 100,000 people ( UNSD, 2018 ).
Tuberculosis incidence per 100,000 population
While the South African incidence rate of TB is significantly higher than the global average, the overall rate has been on a steady decline over the last 10 years.
TB/HIV Co-infection
As noted above by the Red Cross, in Sub-Saharan Africa TB is often the first sign that someone is HIV positive.
The WHO presents 3 important indicators for TB/HIV co-infection.
1. TB patients with known HIV status as a percentage of TB patients
Since 2012, consistently over 90% of TB patients in South Africa are tested for HIV annually ( WHO, 2018 ).
2. TB patients who test positive for HIV
For the last 15 years approximately 60% of South African TB patients have tested positive for HIV ( WHO, 2018 ).
3. HIV-positive TB patients on ART (antiretroviral therapy) (%)
For the last 10 years treatment of South African TB patients with HIV with antiretroviral therapy has been on the rise and now almost matches the positive test case rate ( WHO, 2020 ).
Closing the Gap:
South African legislation is guided in part by the country's National Development Plan and Medium Term Strategic Framework . Due to the roles HIV and TB play in South African society, they also play important roles in those guiding documents.
Additionally, the South African government is moving to what they are calling the ' District Development Model ' which seeks to
"...be a new integrated, district-based, service delivery approach aimed at fast-tracking service delivery and ensure that municipalities are adequately supported and resourced to carry out their mandate.."
Leveraging Data and Data-based Insights for Precision Intervention:
In order to assist decision makers in planning and the distribution of resources, the South African Risk and Vulnerability Atlas project has undertaken to provide publicly available datasets in a form that is suitable for Geospatial Data analysis and visualization.
Building Open access data for decision making.
Step 1: Data Collation and publication
Publicly available datasets are spatially referenced and published within the South African Environmental Observation Networks (SAEON) Open Data Portal (ODP). This entails issuing the data with a Digital Object Identifier, Ensuring that the data metadata is complete and aligned with the SANS 1878 metadata standard and Publishing the data to a searchable catalogue which is available via https://catalogue.saeon.ac.za/.
Step 2: Data is presented in Atlases
Mapped data are turned into themed atlases to make the data easier to find and interpret by decision makers. Data within these atlas views are available for download with complete metadata records.
SAEON SDG 3 Data Atlas (Click the icons on the left to access layer information)
Step 3: Facilitate data analysis
Data Dashboards provide an intuitive interactive mechanism to allow local decision makers to rapidly gain insights on the status of their local population vulnerability and the ability of the local health system to cater for the populations unique situation. Allowing for resources to be focused on issues that are specific to their region.
NRF-SAEON Health Data Decision Support Data- Dashboard
Step 4: SHARE and BUILD an Open Data Community:
Data in distributed to the various stakeholders and analysts via websites such as SARVA, allowing for open access to data for Download and Searching. Additionally, provision is made for Data custodians to publish their data to SAEONS curated Data Collections
- Submit your Data to curation@SAEON.ac.za
Thank you for reading!
For more information contact datascience@SAEON.ac.za
