Low treatment initiation rates among multidrug-resistant tuberculosis patients in Gauteng, South Africa, 2011
OBJECTIVE: To determine treatment uptake among newly diagnosed multidrug-resistant tuberculosis (MDR-TB) patients and risk markers for non-initiation of treatment.
DESIGN: A cross-sectional study was conducted including all newly diagnosed MDR-TB patients in Gauteng Province, South Africa, in 2011. Socio-demographic and clinical characteristics of those who attended Sizwe Hospital, the designated MDR-TB hospital, were extracted from their medical records. District health offices provided data on patients not seen at Sizwe Hospital. Univariate and multivariate analysis were used to determine risk markers for non-initiation of treatment.
RESULTS: Of the 942 newly diagnosed MDR-TB patients in Gauteng, only 593 (63%) initiated treatment. Of these, 70 (11.8%) did not maintain treatment up to the fourth month. Among the 349 (37%) who did not initiate treatment, 31.2% died and 46.4% could not be accounted for. Referral for laboratory diagnosis from hospitals, health district of the laboratory diagnosis, human immunodeficiency virus infection and place of residence were independently associated with non-initiation of MDR-TB treatment.
CONCLUSION: Untreated patients continue to transmit MDR-TB in the community. These study findings highlight the need to identify and target the causes of non-initiation of treatment in specific settings.
Keywords: MDR-TB transmission; death; patient tracing; risk markers; untreated patients
Document Type: Research Article
Affiliations: 1: South African Field Epidemiology and Laboratory Training Programme, National Institute for Communicable Diseases, Sandringham, South Africa; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa 2: Centre for Tuberculosis, National Institute for Communicable Diseases/National Health Laboratory Service, Pretoria, South Africa; Health Protection Agency, London, UK
Publication date: 01 August 2013
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