Tuberculosis (TB) control is failing in South Africa (SA), with current notification rates as high as those reported in the early 1900s.[1,2]Adjusting for population size, SA remains ranked among the 10 countries with the highest incidence rate for TB, despite more than a century of TB control efforts and 75 years of combination TB therapy.[3]The World Health Organization has endorsed an ‘End TB Strategy’ to end the TB global epidemic by 2035. As part of this global strategy, the SA TB control programme has proposed a programme incorporating three strategic pillars: ‘find and link’, ‘treat and retain’ and ‘prevent and prepare’.[1] This approach is predicated on treatment as the major modality for TB control. However, there is little evidence of infectious epidemics being controlled by treatment of clinically symptomatic cases alone. Furthermore, the linkage between TB treatment and transmission is less than certain. In the early 20th century, prior to chemotherapy, TB incidence decreased by 75% in New York and London.[2] In contrast, in Cape Town, one of the first cities to introduce compulsory TB notification, the incidence remained high over the early 20th century.[4] While the introduction of TB therapy markedly decreased TB case fatality equally in each setting, it had little impact on TB notification rate.[2] ….more
