Speaker
Description
Introduction: Tuberculosis (TB) remains the second leading cause of death from a single infectious agent globally. Recurrent TB episodes, defined as individuals diagnosed more than twice between 2019 and 2023, pose significant public health challenges, contributing to poor treatment outcomes, prolonged morbidity, and ongoing transmission, with an incidence of 468 per 100,000 population in South Africa. This study aimed to identify the characteristics of individuals with recurrent TB and to investigate factors associated with unsuccessful treatment outcomes in two high drug-resistant tuberculosis (DR-TB) burden provinces, Gauteng and Western Cape, from 2019 to 2023.
Methods: A cross-sectional study was conducted using secondary data from the Electronic Drug-Resistant Tuberculosis Register, including all individuals diagnosed with DR-TB during the study period. Ethical clearance was obtained from the Centre for TB and the University of the Witwatersrand. Descriptive statistics were generated, followed by univariable analysis to determine crude odds ratios. Multivariable logistic regression was performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals.
Results: A total of 11,481 TB records were included in the analysis. Descriptive analysis showed that the majority of individuals with recurrent TB were male (59.0%), aged between 25–44 years (57.8%), and living with HIV (59.7%). Most cases occurred in the Western Cape (61.9%), with a higher proportion of patients experiencing ≥3 episodes compared to Gauteng. Patients with five TB episodes had significantly higher odds of unsuccessful outcomes (aOR: 2.7; 95% CI: 1.2–6.0). DR-TB individuals in the Western Cape were more likely to experience treatment failure compared to those in Gauteng (aOR: 1.5; 95% CI: 1.3–1.6). Short-course treatment regimens were associated with improved outcomes (aOR: 0.7; 95% CI: 0.6–0.8).
Conclusion: A trend of worsening outcomes and rising complexity (e.g., pre-XDR/XDR-TB) was evident with each additional episode. Treatment failure was much higher in the Western Cape, which may be attributed to higher TB burdens, diagnostic practices, health system differences, or potential delays in care initiation. These findings highlight the need to reinforce strategies addressing loss to follow-up and highlight the potential of short-course regimens in enhancing treatment success and reducing TB transmission.