Tuberculosis remains one of South Africa’s most devastating public health challenges, claiming roughly 50 000 lives annually while falling far short of global reduction targets.
But a major study led by the University of Cape Town offers a powerful path forward. Researchers found that deploying rapid, point-of-care testing, using simple tongue swabs and on-site analysis, could cut future TB cases by up to 49% and deaths by 67% over the next 15 years.
By replacing slow, costly lab-bound sputum tests with immediate diagnostic tools, South Africa has a rare opportunity to fix long-standing healthcare gaps and rewrite its TB trajectory.
While the World Health Organization (WHO) set a goal of an 80% reduction in TB incidence between 2015 and 2030, the nation achieved only a 22% drop from 2015 to 2024.
What the study found
However, new research led by Associate Professor Leigh Johnson from the University of Cape Town (UCT) reveals that deploying rapid point-of-care testing, using accessible tongue swabs or sputum samples, could dramatically alter this trajectory, cutting future TB cases by up to 49% and mortality by 67% over the next 15 years.
The findings, featured in "Global Health Action", utilised the Thembisa mathematical model, which tracks TB and HIV dynamics in South Africa, to evaluate key drivers of future disease trends by adjusting model variables across plausible upper and lower limits.
Johnson, an actuary and epidemiologist at UCT’s Centre for Integrated Data and Epidemiological Research, highlighted that a major hurdle in controlling transmission is the low rate of microbiological testing among symptomatic clinic visitors.
“The current testing protocols require that patients produce sputum specimens, which is difficult for some patients, and those sputum specimens have to be sent to laboratories to be analysed, and then patients have to return to get test results.
"The process is laborious and expensive, and health workers facing high patient volumes often skip it due to time pressure,” he said.
These rapid point-of-care tools represent a breakthrough: they accept simpler tongue swabs alongside traditional sputum, yield immediate on-site results without off-site lab processing and cost significantly less than standard laboratory diagnostics.
“Its accuracy is similar to that of current sputum laboratory-based tests in people with TB symptoms, and WHO has recently endorsed the use of the test in people with TB symptoms,” he said.
Community screening has limits
Johnson stressed, however, that technology alone cannot fix testing shortfalls.
Achieving real progress requires strict tracking of diagnostic rates among symptomatic individuals and dedicating more healthcare personnel to facilitate testing workflows.
The research team also modelled the effects of decentralised community screening, such as door-to-door outreach or mobile clinic units.
These proactive measures showed the potential to lower TB incidence and deaths by up to 38% and 49%, respectively.
“We need to be cautious, though, because the WHO has not yet endorsed the use of the new tests in community settings, due to concerns that they are less accurate in people who are asymptomatic (not experiencing TB symptoms).
"Also, it is much more expensive to do testing campaigns in communities, and further health economic analyses are required to assess whether the health gains justify the additional costs,” he said.
Predicting long-term outcomes also depends heavily on variables like face mask usage and changing post-pandemic social interaction patterns, which currently lack up-to-date post-Covid tracking data.
The role of HIV treatment and prevention
Furthermore, expanding access to antiretroviral therapy (ART) remains a vital lever for controlling fatal outcomes.
“This is an area of particular concern given recent disruptions to US funding. In a worst case scenario, the model estimates that TB mortality could increase by 17% as a result of reductions in ART initiation rates,” he said.
The study underscores the necessity of scaling modern, shorter-course TB preventive therapy (TPT) for high-risk populations, particularly household contacts of infected patients and newly diagnosed HIV patients.
Johnson noted that these updated TPT regimens offer improved efficacy with shorter treatment durations.
While reaching the WHO's 80% reduction benchmark by 2030 appears unlikely for South Africa, implementing a strategic combination of measures could bridge much of the gap.
“We need to strike a balance between fixing the existing gaps in the TB programme and pursuing new technologies, if we are to control TB in South Africa,” Johnson said.
alyssia.birjalal@nationalmg.co.za