Tuberculosis surveillance in Cape Town, South Africa: an evaluation

SETTING: Cape Town, South Africa. OBJECTIVE: To evaluate the current system of tuberculosis surveillance in the Cape Metro region. DESIGN: This evaluation was based on the 'Updated Guidelines for Evaluating Public Health Surveillance Systems' of the Centers for Disease Control and Prevention, modified to render the framework applicable to the context of tuberculosis (TB) surveillance. The evaluation incorporated qualitative exploration of perceptions and experiences of system users. RESULTS: System users were very accepting of the system and were committed to seeing it achieve its purpose within public health. Some individuals expressed concerns about the rigidity of the Electronic TB Register software and its analysis capabilities. Dissemination of TB data and evidence-based action within the Cape Metro region are strong attributes of Cape Town's TB surveillance system. At the time of the evaluation, integration of TB and human immunodeficiency virus (HIV) data was weak, as was multidrug-resistant TB (MDR-TB) surveillance; the South African Tuberculosis Control Programme is developing initiatives to improve these areas. CONCLUSIONS: Cape Metro's TB surveillance is strong, although it would be strengthened by increasing availability of data reflecting TB-I-BY co-infection and MDR-TB. Systems operations could be improved by increasing software flexibility, and increased integration of electronic data across health regions would enhance the capacity and assessment of control efforts.