VZCZCXRO5897
RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #1415/01 0971242
ZNR UUUUU ZZH
R 071242Z APR 06
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 2676
INFO RUCNSAD/SOUTHERN AFRICAN DEVELOPMENT COMMUNITY
RUCPDC/DEPT OF COMMERCE WASHDC
RUEATRS/DEPT OF TREASURY WASHDC
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA 1116

UNCLAS SECTION 01 OF 04 PRETORIA 001415 
 
SIPDIS 
 
SIPDIS 
 
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO 
DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR 
STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU KHILL 
USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT 
ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER 
HHS FOR THE OFFICE OF THE SECRETARY/WSTEIGER, NIH/HFRANCIS 
CDC FOR SBLOUNT AND DBIRX 
 
E.O.  12958: N/A 
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH April 7 2006 ISSUE 
 
Summary 
------- 
 
¶1.  Summary.  Every two weeks, Embassy Pretoria publishes a 
public health newsletter highlighting South African health 
issues based on press reports and studies of South African 
researchers.  Comments and analysis do not necessarily reflect 
the opinion of the U.S. Government.  Topics of this week's 
newsletter cover:  Focus on South Africa and TB; SA's TB Cure 
Rate Still Poor; TB Crisis Plan Targets Four Districts; Western 
Cape's High Cure Rate; Zambia and South Africa Tests 
Effectiveness of Community Public Health Interventions; HIV 
Education in Prisons; Finland and South Africa Collaboration in 
Aids Research; South Africa's Avian Flu Contingency Plan; South 
African Development of AIDS Vaccines; SA Prevents TAC from 
Attending UN AIDS Session; and TAC Plans to Attend UN Session. 
End Summary. 
 
Focus on South Africa and TB 
---------------------------- 
 
¶2.  March 24 was International TB Day and the following 
articles present South African statistics and research on the 
disease.  World Health Organization data shows South Africa 
having the third highest overall TB prevalence in the continent 
after Nigeria and Ethiopia and the fifth highest number of new 
TB cases in 2004 globally just after India, China, Indonesia 
and Nigeria. 
 
SA's TB Cure Rate Still Poor 
---------------------------- 
 
¶3.  Little more than half of all tuberculosis patients are 
cured in South Africa, multi-drug resistant TB is increasing, 
and yet new drug regimens may provide optimism on increasing 
South Africa's TB cure rate of 54%.  In 2003, approximately 
185,000 new TB cases were diagnosed in South Africa, rising by 
94,000 cases in a single year, with 279,000 new TB cases in 
¶2004.  South Africa's cure rate falls short of the World Health 
Organization's goal of 85%.  South Africa has the eighth 
highest TB burden in the world and deaths from untreated TB are 
high.  Dr Lindiwe Mvusi, the Health Department's National TB 
Manager, believes that the increase in cases shows that people 
are reporting to clinics at an earlier stage of their TB 
infection.  Multi-drug resistant (MDR) TB is an increasing 
problem, which does not respond to the usual six-month regimen 
of ordinary TB drugs and needs more expensive drugs that are 
taken for about 18 months.  Usually only half of MDR TB 
patients are cured.  Mvusi said that 1.6% of new TB cases are 
MDR TB while 6.7% of patients who are being retreated for TB 
are diagnosed as having MDR-TB.   HIV is also adding to the TB 
burden, with a high proportion of people with TB also being co- 
infected with HIV.  Professor Valerie Mizrahi, co-Director of 
the Center for Excellence for Bio-medical TB Research at the 
National Health Laboratory Service points to recent 
improvements in TB drug development as reasons for hope.  She 
stated that there have been no new TB drugs for 40 years and 
suddenly, over the last five to 10 years, new research in the 
science underlying TB disease and the bacteria that causes TB, 
there has been renewed interest in the field.  South Africa is 
participating in Phase 2 trials for new drugs and combinations 
to treat TB, with major studies in Cape Town and Durban.  The 
Global Alliance for TB Drug Development thinks new TB drugs 
will be available by 2010.  Source:  Health-e News, March 24. 
 
TB Crisis Plan Targets Four Districts 
------------------------------------- 
 
¶4.  South Africa's TB crisis plan will focus initially on four 
health districts with both poor TB cure rates and many TB 
patients, namely eThekwini metro (Durban), Johannesburg, the 
Nelson Mandela metro (Port Elizabeth) and Amatola district 
(East London).  The official start of the plan began at King 
George V Hospital in eThekwini, the worst performing 
metropolitan area in the country with over 24,000 new TB 
patients in 2004, and a cure rate of less than one in three. 
Health Minister Tshabalala-Msimang cited critical elements to 
the success of the plan as adequate human and financial 
resources, access to laboratory services, better TB reporting, 
recording and referral of patients and a highly visible social 
mobilization and media campaign.  The Minister played down the 
 
PRETORIA 00001415  002 OF 004 
 
 
link between TB and HIV, despite consensus among medical 
experts that HIV is driving the TB epidemic.  While the crisis 
plan includes joint HIV and TB measures, Tshabalala-Msimang 
said that making the link between the two epidemics could mean 
that patients were double stigmatized.  Multi-drug resistant TB 
is a serious problem.  While TB cost between R400 ($67, using 6 
rands per dollar) and R600 ($100) for a six month treatment, it 
cost R24,000 ($400) to treat someone with MDR TB.  Doctors from 
King George Hospital, which has one of the biggest MDR TB case 
loads in the country, said there was little information about 
how the MDR TB drugs interacted with antiretroviral drugs. 
Source:  Health e-News, March 24. 
 
Western Cape's High Cure Rate 
----------------------------- 
 
¶5.  Two Western Cape health districts are recording in excess 
of 80% TB cure rates.  Dr. Keith Cloete, acting head of the 
provincial health department, attributes this to patient 
monitoring and committed staff.  The Eden district which 
includes Knysna, George, Plettenberg Bay, Oudtshoorn, 
Riversdale and Beaufort West had 5,366 TB patients in 2004 and 
recorded a cure rate of 81.8%.  The Overberg district which 
includes Caledon cured 84.5% of its 2,437 patients in 2004. 
The Cape Town metropolitan area had 25,824 TB cases in 2004, 
with a cure rate of 64.8%.  Numbers in Cape Town have increased 
significantly at clinics in areas such as Khayelitsha and 
Nyanga where the TB epidemic is being fuelled by the HIV 
epidemic.  The Western Cape Province has increased funding to 
the TB program which will be used to employ more staff, channel 
more money to the non-governmental sector for treatment 
supporters and increase capacity at the laboratories.  Five sub- 
districts will receive more funding in 2006: the Breede Valley 
(Worcester), Drakenstein (Paarl), Eastern (Helderberg and 
Oostenberg), Khayelitsha and Klipfontein (Old Nyanga and 
Athlone).  In 2005 Klipfontein had 3,769 TB cases and 
Khayelitsha 5,640 with cure rates of 67.9% and 51.7%, 
respectively.  The Western Cape's TB cases have increased from 
27,509 cases in 1997 to 47,603 in 2005.  Source:  SAPA, March 
23; Health E-News, March 24. 
 
Zambia and South Africa Test Effectiveness of Community Public 
Health Interventions 
--------------------------------------------- ----------------- 
 
¶6.  Zamstar, the Zambia South Africa Tuberculosis and AIDS 
Reduction Study, is trying to improve TB treatment by focusing 
on public health interventions in 8 communities in the Western 
Cape and 16 in Zambia.  Clinic-based HIV and TB interventions 
are a critical part of the study, with both TB and HIV services 
working closely together.  All TB patients will be tested for 
HIV and all patients going for Voluntary Counseling and Testing 
at the HIV Clinic will be referred for TB testing.  At 
community level, awareness will also be raised using simple 
messages.  In schools, Zamstar workers will be raising TB 
awareness from grade one to 12, moving from school to school 
and setting up sputum (mucus) collection points.  Zamstar's aim 
is to ensure that every person in the target communities will 
be able to give a sputum sample at least three times a year to 
a place which is within a 30 minute walk.  Community health 
workers will also be doing household interventions where TB has 
been diagnosed.  These homes will be viewed as being at risk of 
HIV and TB.  In 2009, prevalence studies will be done where 
5,000 adults will be tested for TB, key to establish how many 
people remained undiagnosed despite the interventions. 
 
¶7.  In South Africa, Nyanga, Phillipi, Khayelitsha Site C, 
Harare, Wallacedene, Delft-South, Kayamandi and Mbekweni/Phola 
Park will participate.  A quality assurance team will travel 
between South Africa and Zambia to monitor among others the 
quality of the interventions as well as the laboratory 
services.  The South African study is run in close 
collaboration with the Provincial TB Program and TB services in 
the Cape Town metro.  The community interventions, which will 
last three years, start in April.  It has already taken 18 
months to get support from the community and establish a 
community advisory board.  Source:  Health e-News, March 24. 
 
HIV Education in Prisons 
------------------------ 
 
 
PRETORIA 00001415  003 OF 004 
 
 
¶8.  A study by the South African Medical Research Council 
points to success in education prevention interventions aimed 
at sexually transmitted diseases for male South African 
prisoners.  Dr. Sibusiso Sifunda studied four prisons, two in 
KwaZulu-Natal and two in Mpumalanga, and found that HIV 
education programs with participation by former inmates led to 
safer sex along with intentions to reduce risky behavior in 
sexual encounters.  According to Sifunda, appropriate education 
would provide the prisoners critical life skills and would help 
prevent additional infections of sexually-transmitted diseases. 
Low prisoner education served as a major barrier to traditional 
health education techniques, such as government-issued 
leaflets.  The study reported that most inmates will have sex 
within the first few days of being released, risking increased 
transmission.  Source:  Cape Argus, March 30. 
 
Finland and South Africa Collaboration in AIDS Research 
--------------------------------------------- ---------- 
 
¶9.  The Perinatal HIV Research Unit (PHRU) and FIT Biotech, a 
Finnish biotechnology company, will collaborate to test the 
safety of a vaccine that may control the progression of HIV to 
AIDS.  This is the first vaccine aimed at already infected 
individuals and the clinical trial will determine the dosage as 
well as the best way to administer the vaccine.  According to 
the clinical trial's principal investigator, Dr. Eftyhia 
Vardas, clinical virologist at PHRU, the vaccine would keep the 
viral load of infected individuals down, while increasing the 
person's CD4 cells.  According to the SA AIDS Vaccine 
Initiative, phase-one safety studies on the vaccine were 
completed in Finland and showed an excellent safety profile. 
South African enrollment began at the end of March with 
suitable candidates being HIV-positive, between the ages of 18 
and 40, with a CD4 count greater than 400 and not on anti- 
retroviral treatment.  The target enrollment is 54 patients in 
South Africa and another 6 in Finland.  The phase 2 study would 
last one year.  Source:  The Star, March 31. 
 
South Africa's Avian Flu Contingency Plan 
----------------------------------------- 
 
¶10.  South Africa has started strict import controls and an 
extensive surveillance program to prevent an outbreak of the 
H5N1 avian flu.  South Africa has yet to record a positive case 
of avian flu among domestic or wild birds within its borders 
and authorities want to ensure that this continues.  The 
contingency plans include:  (1) banning the import of live 
birds from any countries where the virus has been confirmed; 
(2) quarantining and testing any birds imported from virus-free 
countries; and (3) prohibiting the import of live pigs from 
affected countries.  Surveillance of wild birds, domesticated 
ostriches, commercial and non-commercial chickens will be done 
every 6 months in different areas.  In the event of an 
outbreak, immediate quarantine, culling and vaccination of 
staff and labor in contact with infected birds will begin.  A 
Disease Control Center will coordinate the necessary actions to 
handle the disease outbreak.  The national Department of Health 
has sent its preparedness plan to Cabinet for endorsement and 
once endorsed, the plan will be public.  Source:  Pretoria 
News, March 28. 
 
South African Development of AIDS Vaccines 
------------------------------------------ 
 
¶11.  Dr. Glenda Gray, co-Director of the Perinatal HIV Research 
Unit expects that a South African AIDS vaccine might be 
available within four to five years.  Two locally-developed 
vaccines had already been tested for effectiveness in mice and 
baboons and showed promising results.  Gray hoped that human 
trials would start in Africa and America in January or February 
¶2007.  South African research is concentrating on the sub-type 
C HIV epidemic, accounting for 50% of global infections. 
Research in Europe concentrated on sub-type B HIV.  Gray 
worries that so much research is concentrated on the vaccine 
itself, without considering manufacturing or dispensation 
problems that might block the most effective HIV/AIDS 
treatment.  Other South African medical analysts were not as 
optimistic about the five year vaccine availability.  Michelle 
Galloway of the Medical Research Council agreed with Gray's 
assessment of the quality of South African vaccine research, 
yet sounded a cautionary note about the development speed, 
 
PRETORIA 00001415  004 OF 004 
 
 
noting that the first and second phase typically takes two to 
three years each while the third phase takes between three and 
five years.  She also stated that it took 20 to 30 years to 
develop vaccines for other viruses, and HIV is more complex. 
Source:  City Press, April 2. 
 
SA Prevents TAC from Attending UN AIDS Session 
--------------------------------------------- - 
 
¶12.  Due to objections from the national Department of Health, 
the Treatment Action Campaign (TAC) and its affiliate, the AIDS 
Law Project will not be able to attend the UN General 
Assembly's special session on AIDS, scheduled for May 31 to 
June 2.  According to Thami Mseleku, the Director-General of 
Health, the Department objected to TAC's presence because they 
used previous global forums to vilify the government.  He said 
that the government would rather resolve its differences with 
the TAC within the country.  Mseleku said that this decision 
had been made by the Health Department without consulting the 
President's office.  Source:  Sunday Independent, April 2; The 
Mercury, April 3. 
 
TAC Plans to Attend UN Session 
--------------------------------- 
 
¶13.  The Treatment Action Campaign (TAC) plans to attend the 
late May UN session on AIDS by being included as 
representatives of other non-governmental organizations if they 
are not included in the South African government's official 
country delegation.  Mark Heywood, a member of the TAC 
executive committee has stated that a number of already 
accredited organizations have offered TAC places in their 
delegations.  The TAC and the Aids Law Project are two of six 
organizations worldwide denied accreditation for participation. 
Source:  Pretoria News, April 6. 
 
TEITELBAUM