Low treatment initiation rates among multidrug-resistant tuberculosis patients in Gauteng, South Africa, 2011

Int J Tuberc Lung Dis. 2013 Aug;17(8):1043-8. doi: 10.5588/ijtld.13.0071.


Setting: Gauteng, South Africa.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / administration & dosage*
  • Antitubercular Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • HIV Infections / epidemiology*
  • Humans
  • Infant
  • Male
  • Medication Adherence*
  • Middle Aged
  • Multivariate Analysis
  • Referral and Consultation / statistics & numerical data
  • Risk Factors
  • South Africa / epidemiology
  • Tuberculosis, Multidrug-Resistant / drug therapy*
  • Tuberculosis, Multidrug-Resistant / epidemiology
  • Tuberculosis, Multidrug-Resistant / transmission
  • Young Adult


  • Antitubercular Agents