Tuberculosis case finding in South Africa

South Africa is one of the 22 tuberculosis (TB) high burden countries in the world according to the World Health Organisation. TB is the main cause of death in South Africa with TB mortality at 49 (95% CI 21-87) per 100,000 population in 2011. In 2011 TB prevalence was estimated to be 768 (95% CI 399-1250) per 100,000 and TB incidence 933 (95% CI 819-1180) per 100,000. A quarter of notified cases in Africa are from South Africa. TB is acknowledged by the South African government as a major threat to the health of the South African population. TB is a notifiable disease and is recorded and reported (Health Act, Act No. 61 Of 2003) to the local, provincial and/or national Health Departments. The directly observed therapy, short course (DOTS) strategy was introduced in South Africa in 1999. TB case finding is a crucial element of the TB control strategy since it identifies the source of infection in a community, indicating the individuals who are emitting Mycobacterium tuberculosis bacilli. By treating these individuals thereby making them non-infectious, the transmission chain is cut. Possible ways of case finding are illustrated in the ‘onion model’ and Piot model which include the following steps: developing TB, contact with health service, TB diagnosis, start of TB treatment, and treatment completion. The overall aim of this thesis was to evaluate gaps regarding case finding according to the ‘onion model’ in the South African National TB Programme.