How effectively are rifampicin-resistant TB patients in Gauteng linked to care and initiated on treatment?
Tuberculosis (TB) is a contagious bacterial infection caused by Mycobacterium tuberculosis that primarily affects the lungs but can spread to other parts of the body. Common symptoms include a persistent cough, fever, night sweats, and weight loss. Without timely diagnosis and treatment, TB can lead to severe illness or death.
Globally, TB remains one of the leading causes South Africa remains among the 30 high-burden countries for both TB and drug-resistant TB, with an incidence rate of 427 cases per 100 000 people in 2023. Drug-resistant TB develops when the bacteria become resistant to medicines such as rifampicin, one of the most powerful first-line drugs used to treat TB.
Rifampicin-resistant (RR) TB is particularly concerning due to its more complex and prolonged treatment of illness and death from infectious diseases, with millions of new cases reported each year.
Ensuring that patients diagnosed with RR-TB are promptly linked to care is essential to reduce transmission and improve outcomes. The National Strategic Plan for South Africa sets a target of 95% linkage to care and treatment initiation within seven days of diagnosis.
The following report presents RR-TB surveillance findings from Gauteng province between 2022 and 2023, based on data from the Centre for Tuberculosis (CTB) at the National Institute for Communicable Diseases (NICD) and the Gauteng Department of Health’s HIV and AIDS, Sexually Transmitted Infections, Tuberculosis (HAST) programme.
Materials and Methods
A descriptive study was carried out by analysis of secondary data. The study utilised RR-TB RFA obtained from CTB at the NICD and treatment initiation feedback information from the TB managers in Gauteng.
All individuals of any age tested at a public facility with a positive TB NAAT and an RR-TB detected in Gauteng in 2022 and 2023 were included in the study. Patients who had a second positive test within the same year were considered duplicates and were excluded from the study. Therefore, only one episode of RR-TB per person was considered per year.
The CTB designed an automated alert system through the Corporate Data Warehouse (CDW), hosted by the NHLS, to send out positive RR-TB NAAT results to stakeholders weekly. The weekly RFA includes RRTB NAAT results for all public health facilities in all provinces, including Gauteng.
Results
According to the RR-TB RFA consolidated data, Gauteng identified 867 and 895 RR-TB NAAT cases in 2022 and 2023, respectively, with Johannesburg Health District reporting the highest proportion of cases (2022: 302/867, 35% and 2023: 386/895, 43%).
In 2022, the treatment initiation rate was 83% (721/867) and increased to 89% (798/895) in 2023. For both years, all districts initiated more than 50% of their cases on treatment within one week after diagnosis, except for Sedibeng District (30/76; 44%) and West Rand District (34/77; 49%), both in 2023.
For a more in-depth look into this thought-provoking report, download the full article below.
