Gender patterns of tuberculosis testing and disease in South Africa

SETTING: In South Africa, tuberculosis (TB) has been the leading cause of death for over a decade. The TB incidence rate is the second highest in the world, and continues to rise.

OBJECTIVE: To examine gender patterns in South Africa's TB epidemic. This is one of the first studies to use National Health Laboratory Service (NHLS) data to evaluate the epidemic at the national level.

DESIGN: Observational study using NHLS retrospective data for every TB test performed in public health facilities between 2009 and 2011.

RESULTS: Despite an increase in the number of TB tests performed, the number of TB cases remained relatively constant. Although prevalence rates differ between health districts, we find a similar female-to-male ratio (0.70) in each district. The age profile for TB resembles that of human immunodeficiency virus (HIV), with peak TB prevalence in women occurring 7 years earlier than in men. The female-to-male ratio of TB cases and 3+ positive (severe) cases decreases rapidly between ages 25 and 35 years.

CONCLUSION: These age and gender patterns are driven by the HIV epidemic and risks associated with pregnancy and childbearing. Increasing the quality and quantity of active TB case finding at existing points of care would be a sustainable and cost-effective intervention for both treatment and prevention.