Gauteng study reveals gaps in treatment for drug-resistant TB patients

A new analysis from the National Institute for Communicable Diseases (NICD) has found that many Gauteng patients diagnosed with rifampicin-resistant tuberculosis (RR-TB) are still not starting treatment quickly enough - a delay that increases the risk of transmission, complications and death.

RR-TB is a form of drug-resistant TB that does not respond to rifampicin, one of the key first-line TB medicines. The study focused specifically on Gauteng cases diagnosed between 2022 and 2023, examining how many patients were linked to care, how long they waited to begin treatment, and why some never started it at all.

According to the NICD, TB remains the sixth leading cause of death in South Africa, and mortality is significantly higher in patients who are not quickly initiated on the correct drug-resistant treatment.

The province has introduced several interventions aligned with the national End TB Strategy, aimed at reducing delays between diagnosis and treatment. These include improved tracing, counselling and follow-up systems. The NICD says ongoing evaluation is essential to determine whether these efforts are working.

Lead investigator Nomathamsanqa Ndhlovu, an epidemiologist at the NICD’s Division of Public Health Surveillance and Response, said the study aims to better understand where patients are falling through the cracks.

“This article describes rifampicin-resistant tuberculosis (RR-TB) patients who were initiated on RR-TB treatment and shares reasons for non-initiation in patients who didn’t commence treatment in Gauteng. The article further reports how long it took for patients to start taking treatment from the day that they were diagnosed with RR-TB.”

She said the research is vital because of South Africa’s high burden of drug-resistant TB. “South Africa is a high-burden country for drug-resistant (DR) TB, and TB is one of the leading causes of death. In order to interrupt transmission of the disease and decrease its spread and resultant deaths, it is vital to ensure that all patients are initiated on DR-TB treatment in the shortest time possible.”

Ndhlovu said she was drawn to this research because TB is both preventable and curable, and the gap lies in ensuring that diagnosed patients remain connected to the health system. “TB is preventable and curable. Therefore, the opportunity to fight this disease exists through linking patients to care for treatment and ensuring that fewer patients are untraceable after RR-TB diagnosis.”

She also explained her role in the publication. “As an epidemiologist who has been collating and analysing this data over time, I had the opportunity to conceptualise the publication and write up the findings of this project.”

Ndhlovu said the article is important reading for anyone working in TB, as it highlights progress but also clear gaps in Gauteng’s treatment pathway. “The article reports progress made in RR-TB treatment initiation rates in Gauteng and highlights gaps that may provide insights for future interventions to address and improve treatment initiation.”

She hopes the findings will push for stronger support for patients immediately before and after diagnosis. “I hope that this article will encourage healthcare workers to strengthen pre-testing and post-testing counselling for RR-TB patients, to increase patients’ likelihood of remaining linked to care. Furthermore, I hope that the need for an integrated information system for the entire TB cascade will be supported through this article.”