BackgroundDaily directly-observed therapy (DOT) is recommended for rifampicin-resistant tuberculosis (RR-TB) patients throughout treatment. We assessed the impact of self-administered treatment (SAT) in a South African township with high rates of RR-TB and HIV.MethodsCommunity-supported SAT for patients who completed the intensive phase was piloted in five primary care clinics in Khayelitsha. We compared final treatment outcomes among RR-TB patients initiating treatment before (standard-of-care (SOC)-cohort, January 2010-July 2013) and after the implementation of the pilot (SAT-cohort, January 2012-December 2014). All patients with outcomes before January 1, 2017 were considered in the analysis of outcomes.ResultsOne-hundred-eighteen patients in the SOC-cohort and 174 patients in the SAT-cohort had final RR-TB treatment outcomes; 70% and 73% were HIV-co-infected, respectively. The proportion of patients with a final outcome of loss to follow-up (LTFU) did not differ whether treated in the SOC (25/118, 21.2%) or SAT-cohort (31/174, 17.8%) (P = 0.47). There were no significant differences in the time to 24-month LTFU among HIV-infected and uninfected patients (HR 0.90, 95% CI: 0.51–1.6, P = 0.71), or among patients enrolled in the SOC-cohort versus the SAT-cohort (HR 0.83, 95% CI: 0.49–1.4, P = 0.50) who received at least 6-months of RR-TB treatment.ConclusionThe introduction of SAT during the continuation phase of RR-TB treatment does not adversely affect final RR-TB treatment outcomes in a high TB and HIV-burden setting. This differentiated, patient-centred model of care could be considered in RR-TB programmes to decrease the burden of DOT on patients and health facilities.

Here we report on the final outcomes for the cohort of 103 patients, 77% HIV-positive with a median (interquartile range, IQR) CD4 count of 141 (61-252) cells per mm 3 , from Khayelitsha, South Africa who initiated regimens containing delamanid (Dlm) for the treatment of rifampicin-resistant tuberculosis (RR-TB) from November 2015 to August 2017 [1]. The median (IQR) duration on Dlm was 6.3 (4.3-12.0) months; 54 (52%) patients received Dlm for more than 6 months and 32 (31%) also received a regimen containing bedaquiline (Bdq), 26 (81%) of whom harboured fluoroquinolone (Fq) resistant strains.

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