Outcomes of treatment of drug-susceptible tuberculosis at public sector primary healthcare clinics in Johannesburg, South Africa: A retrospective cohort study

Abstract

Background.Despite the large number of tuberculosis (TB) patients treated in South Africa (SA), there are few descriptions in the published literature of drug-susceptible TB patient characteristics, mode of diagnosis or treatment outcomes in routine public sector treatment programmes. Objective. To enhance the evidence base for public sector TB treatment service delivery, we reported the characteristics of and outcomes for a retrospective cohort of adult TB patients at public sector clinics in the Johannesburg Metropolitan Municipality (JHB), SA. Methods. We collected medical record data for a retrospective cohort of adult (≥18 years) TB patients registered between 1 April 2011 and 31 March 2012 at three public sector clinics in JHB. Data were abstracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. We report patient characteristics, mode of diagnosis, mode of treatment supervision, treatment characteristics, HIV status and treatment outcomes for this cohort. Results. A total of 544 patients were enrolled in the cohort. Most (86%) were new TB cases, 81% had pulmonary TB, 58% were smearpositive at treatment initiation and 71% were HIV co-infected. Among 495 patients with treatment outcomes reported, 80% (n=394) had successful outcomes, 11% (n=55) were lost to follow-up, 8% (n=40) died and 1% (n=6) failed treatment. Conclusions. Primary healthcare clinics in JHB are achieving relatively high rates of success in treating drug-susceptible TB. Missing laboratory results were common, including follow-up smears, cultures and drug susceptibility tests, making it difficult to assess adherence to guidelines and leaving scope for substantial improvements in record-keeping at the clinics involved.

The impact of implementing a Xpert MTB/RIF algorithm on drug-sensitive pulmonary tuberculosis: a retrospective analysis

“…However, the information obtained from this analysis adds to our current understanding of the TB programme in South Africa and highlights areas that need more attention. The high rates of empirically-treated TB, even with access to Xpert testing, are in line with other evidence from this setting [26,27], and remained high despite improvements in coverage of microbiological testing. Our data support prior calls to address the weaknesses in the current algorithm in terms of diagnosing TB in HIV positive people with Xpert-negative results and the lack of guidance in monitoring these cases [27,28].…”

The costs and outcomes of paediatric tuberculosis treatment at primary healthcare clinics in Johannesburg, South Africa

“…[28] Other problems with record keeping were also evident, as most of those who were reported as cured were missing the laboratory evidence needed to confirm this outcome. This issue has been noted in the treatment records of adult TB patients, [15] and suggests that careful staff training and performance monitoring are needed. We also observed limited contact tracing, which is of added concern because data from Soweto, Johannesburg, have shown high rates of undiagnosed TB and HIV in the household contacts and caregivers of children with TB.…”

Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: a systematic review and meta-analysis

“…In addition, epidemiological studies show varying rates of treatment success across TB programme. For instance, studies show TSR of 82.2%13 and 80%14 in South Africa; 90.1%15 and 86.8%16 in Ethiopia; 39%17 in Uganda; 70% in Zimbabwe18 and 57.7%19 in Nigeria.…”