Treatment initiation among persons diagnosed with drug-resistant TB in Johannesburg, South Africa
Abstract
Background
In South Africa, roughly
half of the drug-resistant TB cases diagnosed are reported to
have been started on treatment. We determined the proportion of
persons diagnosed with rifampicin resistant (RR-) TB who
initiated treatment in Johannesburg after the introduction of
decentralized RR-TB care in 2011.
Methods
We retrospectively matched
adult patients diagnosed with laboratory-confirmed RR-TB in
Johannesburg from 07/2011-06/2012 with records of patients
initiating RR-TB treatment at one of the city’s four
public sector treatment sites (one centralized, three
decentralized). Patients were followed from date of diagnosis
until the earliest of RR-TB treatment initiation, death, or 6
months’ follow-up. We report diagnostic methods and
outcomes, proportions initiating treatment, and median time from
diagnosis to treatment initiation.
Results
594 patients were enrolled
(median age 34 (IQR 29–42), 287 (48.3%) female). Diagnosis
was by GenoType MTBDRplus (Hain-Life-Science) line probe assay
(LPA) (281, 47.3%), Xpert MTB/RIF (Cepheid) (258, 43.4%), or
phenotypic drug susceptibility testing (DST) (30, 5.1%) with 25
(4.2%) missing a diagnosis method. 320 patients (53.8%) had
multi-drug resistant TB, 158 (26.6%) rifampicin resistant TB by
Xpert MTB/RIF, 102 (17.2%) rifampicin mono-resistance, and 14
(2.4%) extensively drug-resistant TB. 256/594 (43.0%) patients
initiated treatment, representing 70.7% of those who were
referred for treatment (362/594). 338/594 patients (57.0%) did
not initiate treatment, including 104 (17.5%) who died before
treatment was started. The median time from sputum collection to
treatment initiation was 33 days (IQR 12–52).
Conclusion
Despite decentralized
RR-TB treatment, fewer than half the patients diagnosed in
Johannesburg initiated appropriate treatment. Offering treatment
at decentralized sites alone is not sufficient; improvements in
linking patients diagnosed with RR-TB to effective treatment is
essential.
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Source:
PLOS ONE
