End TB Plan 1.0

Objectives

End TB Plan 1.0 is South Africa’s 2026/27 implementation plan for accelerating progress towards ending tuberculosis (TB) as a public health threat. It aligns with the National TB Strategic Plan 2023–2028, the national HIV, TB and sexually transmitted infections strategy, and the World Health Organization End TB Strategy, while addressing remaining gaps in mortality, case-finding, treatment coverage and catastrophic household costs.[1][2]

• Strengthen demand creation, advocacy and strategic communication to increase awareness, reduce stigma, engage communities and promote timely use of TB services.[3][4]
• Find and link people with TB through expanded screening, early diagnosis, testing innovations and reliable referral and linkage-to-care pathways, with attention to children, people living with HIV, people with drug-resistant TB and other priority populations.[3][5]
• Treat and retain people through integrated, person-centred care, differentiated treatment models, clinical capacity-building, patient support, treatment-interruption monitoring and mortality audits.[3][6]
• Prevent and prepare by scaling up TB preventive treatment, strengthening infection prevention and control, addressing social drivers, and preparing for the introduction and scale-up of new TB vaccines.[2][7]
• Monitor and assess the response through improved routine data quality, accessible dashboards, programme evaluation, data-driven improvement and strengthened accountability, including in mines and mining communities.[3][8]

Key 2026/27 objectives include completing five million first-line TB nucleic acid amplification tests, conducting nine demand-creation campaigns, initiating 286,587 TB contacts and 314,480 people living with HIV on TB preventive treatment, and maintaining three functional TB dashboards.[9][10][11]The plan seeks successful-treatment proportions of 88% for drug-susceptible TB and 74% for drug-resistant TB, alongside loss-to-follow-up targets of 7% and 8% respectively.[9][10]

The plan builds on substantial reductions in TB incidence, from 988 per 100,000 population in 2015 to 389 per 100,000 in 2024, but recognises that TB deaths declined less sharply, from 65,000 to 54,000 over the same period.[2]It also responds to persistent financial hardship, with 56% of TB-affected households experiencing catastrophic costs in 2024, against an End TB target of zero.[2]

Implementation

Implementation runs from 1 April 2026 to 31 March 2027 under the leadership of the National TB Programme, using coordinated action across national, provincial, district and facility levels.[3][12]Delivery combines community outreach, primary healthcare, laboratory and clinical services, HIV-programme integration, differentiated care, surveillance, quality improvement and multi-sectoral collaboration.[4][12]

• Organise national delivery through functions for advocacy, communication and social mobilisation; drug-susceptible TB; drug-resistant TB and TB in mines; research, information, monitoring, evaluation and surveillance; and technical support.[3]
• Develop national operational plans with budget allocations and support provinces to prepare costed plans aligned with national priorities; district and facility teams are expected to translate these plans into service delivery, supervision and improvement activities.[11][12]
• Expand diagnostic access through diversified nucleic acid amplification testing, routine testing for second-line drug resistance, stool testing for young children, urine lipoarabinomannan testing, digital chest X-ray screening and a near point-of-care testing pilot by March 2027.[1][5]
• Implement treatment innovations, including a four-month drug-susceptible TB regimen for children and six-month drug-resistant TB regimens as standard care where specified, while monitoring outcomes, adverse events and post-treatment follow-up.[1][6][13]
• Strengthen prevention through updated infection prevention and control guidance, TB preventive treatment for eligible contacts and people living with HIV, and a country roadmap for new TB vaccines.[6][7]
• Maintain supplies of TB medicines, laboratory commodities and other essential inputs, and strengthen patient tracing, facility outreach, community linkages and referral systems.[12]

Governance and implementation involve the national health department, provincial and district health teams, the National Institute for Communicable Diseases, National Health Laboratory Service, primary healthcare and pharmaceutical services, the South African National AIDS Council, research institutions, technical partners, donors, civil society, communities, TB patients and survivors.[14][11]The plan also coordinates with departments responsible for social development, mineral resources and energy, correctional services, basic education, and higher education and training, alongside professional bodies, labour, private-sector and traditional health practitioner organisations.[5]

Mining-sector action includes coordination with the Department of Mineral Resources and Energy, review of the mining monitoring framework, referral pathways for ex-mineworkers who screen positive, integration of mining data into national reporting, and quarterly monitoring of mining indicators.[8][15][16]

Performance management uses the public TB dashboard hosted by the National Institute for Communicable Diseases, routine programme data, Results for Action reports, weekly alerts, treatment line lists, laboratory turnaround-time monitoring, data-quality audits, supervisory visits, clinical and mortality audits, external programme reviews and monthly, quarterly and annual progress reports.[17][12][13]Indicators cover testing, notifications, treatment initiation and outcomes, preventive treatment, treatment interruption, data completeness, medicine availability, hotspot trends and mining-sector reporting.[8][9][12]

Financing arrangements require budgeted national plans and costed provincial and district plans.[11][12]The plan calls for coordination of domestic and Global Fund financing, and identifies technical support from the Global Fund, the Technical Support Unit and other partners, but the supplied material does not specify total budgets, allocations, funding gaps or monetary values.[5][16]

Monitoring & Evaluation

The plan establishes a comprehensive monitoring, evaluation and accountability system for the April 2026 to March 2027 tuberculosis response, centred on routine data quality, accessible dashboards, performance reporting, surveillance, quality improvement and oversight of services in mines and mining communities.[3][8][11]

• Track the tuberculosis cascade through indicators for testing, notifications, treatment initiation and outcomes, treatment interruption and loss to follow-up, preventive treatment, child case-finding, drug-resistant tuberculosis, mortality, and catastrophic costs among tuberculosis-affected households.[18][2][6]
• Use the public tuberculosis dashboard, launched on the National Institute for Communicable Diseases website in October 2025, to improve transparency and provide timely access to programme performance data.[17]
• Report first-line tuberculosis nucleic acid amplification testing daily through the End TB Dashboard; report preventive treatment monthly through the District Health Information System; and use quarterly directorate, laboratory, clinical, treatment, audit, supervisory, grant and mining reports.[9][10][11]
• Produce monthly, quarterly and annual national implementation reports, alongside quarterly progress reports, conditional-grant business-plan reviews and mining-sector monitoring reports.[8][11][12]
• Strengthen data quality and access through functional dashboards, regular data audits, data-quality improvement reports, complete information systems, provincial and district cascades, joint tuberculosis and HIV supervisory visits, and meetings with provincial managers.[8]
• Use Results for Action reports, weekly tuberculosis alerts, geospatial hotspot mapping, outbreak surveillance, drug-resistant tuberculosis line lists, turnaround-time monitoring and sputum-rejection dashboards to identify service gaps and guide action across national, provincial, district and facility levels.[5][12]
• Monitor diagnostic and linkage performance through numbers tested with first-line tests, stool testing among children, urine lipoarabinomannan quality-assurance reports, digital chest X-ray results, verified patient registration, and assessment reports for point-of-care and short-message-service notification pilots.[5][6]
• Assess treatment and retention through initiation, enrolment in the Central Chronic Medicine Dispensing and Distribution system, post-treatment testing for successfully treated drug-resistant tuberculosis patients, treatment interruption, loss to follow-up, clinical training, and clinical and mortality audits.[6]
• Measure prevention through the number of contacts and people living with HIV initiated on tuberculosis preventive treatment, and assess vaccine preparedness through the country roadmap and records of research and implementation-support meetings.[7]
• Evaluate mining-sector accountability through situational analyses, coordination minutes, referral procedures for ex-mineworkers, revision of the DMR 164 form, and quarterly inclusion of mining indicators in programme reports.[8][15][16]

Reported performance indicates both progress and outstanding gaps. Approximately 3.6 million tuberculosis tests were conducted in the reported period, representing 72% of the five-million national target and a 10% increase from 2024.[17]Annual notifications have remained between 200,000 and 230,000 since 2022, but the plan identifies continuing risk that people with incident tuberculosis remain undiagnosed or untreated.[19]Drug-susceptible tuberculosis treatment success was 81% in 2024, below the 85% target, whereas success among people starting six-month drug-resistant tuberculosis regimens was 79%, above the 75% target.[19]

Targets for 2026/27 include five million first-line tuberculosis tests, three functioning tuberculosis dashboards, four data-quality improvement reports, nine provincial monitoring and evaluation cascades, four joint tuberculosis and HIV supervisory reports, one external programme review, four conditional-grant reports, two hotspot reports, seven leadership workshops, five mining situational analyses and four consultations with the Department of Mineral Resources and Energy.[9][10][11]Accountability is reinforced through clinical and mortality audits, data-quality audits, programme reviews, conditional-grant reporting, technical task teams, advisory structures and civil-society participation.[10][11][13]

Costing & Financing

Financing is framed as a requirement for sustainable delivery rather than through a quantified financial plan. The plan calls for mobilisation and coordination of domestic and Global Fund financing for tuberculosis priorities, including communication and social mobilisation, surveillance and service-delivery innovations.[5]National operational plans are to include budget allocations for all tuberculosis interventions, while provincial and district operational plans are to be costed and aligned with national priorities.[11][12]

• Support sustainable financing for the tuberculosis response as an objective under the Communicate and Advocate pillar.[3]
• Use Global Fund support, the Technical Support Unit and other partners for technical assistance, mentorship and targeted quality-improvement interventions.[16]
• Recognise household economic burden as a core outcome: 56% of tuberculosis-affected households experienced catastrophic costs in 2024, against End TB targets of 0% in 2025, 2030 and 2035.[2]
• Note that the supplied material does not provide a total programme budget, intervention-level allocations, expenditure estimates, monetary funding gaps, currency amounts or wider economic assumptions.[11][12]

Technical support funded by the Gates Foundation and contributions from donors and implementing partners are acknowledged, but no financial values are provided.[14]