Tuberculosis and HIV in South Africa

Tuberculosis and HIV in South Africa

South Africa has one of the most severe epidemics of tuberculosis in the world. TB incidence is at nearly 1%, and some 400,000 cases are reported per year.  Estimated TB prevalence doubled between 1990 and 2010, largely as a result of the HIV epidemic. At the same time South Africa bears a disproportionate share of the world’s epidemic of drug-resistant tuberculosis (DR-TB), with more than 15,000 cases of multi-drug resistant TB (MDR-TB) alone reported in 2012. TB in all its forms is the country’s leading cause of death with 88000 tuberculosis related deaths in 2012. The diagnosis and treatment of DR-TB consumes a third of national TB budget even though < 10% of South African TB cases are drug resistant.

Controlling the TB epidemic is a high priority of the South African government.  Achieving that goal will require the kind of epidemiologic and economic data that HE2RO can provide. Through our operational research, we are generating information about the delivery, outcomes, and costs of both drug-sensitive and drug-resistant TB and its impact on patients and their households.


  • Linkages to Care for Patients Diagnosed with Drug-Resistant Tuberculosis within the City of Johannesburg

    Nationally, in the most recently reported cohort of patients (2011), only 56% of patients with laboratory-confirmed MDR-TB initiated 2nd line TB treatment. The National Strategic Plan for HIV, TB, and STIs 2012-2016 set an ambitious target of 100% initiation. Because of the complexity of the referral and linkage process and the fragmentation of the records amongst various registers, the proportion of patients completing each step (sample collection, diagnosis of resistance, reporting of 
  • Costs and Outcomes Analysis of Decentralized, Deinstitutionalized Drug-Resistant Tuberculosis Management at a Johannesburg Hospital

    The overall aim of this medical record review observational cohort study is to analyse the cost and outcomes of decentralized, deinstitutionalized drug-resistant TB (DR-TB) management at an outpatient specialized clinic in Johannesburg. In August 2011, the South African National Department of Health adopted guidelines regarding MDR-TB treatment, “Decentralised Management of Multidrug-Resistant Tuberculosis: A Policy Framework for South Africa.” These guidelines recommend that acid fast 
  • Adverse Events of Treatment in a Decentralized Drug-Resistant Tuberculosis Clinic in Johannesburg, South Africa

    The overall aim of this study is to review adverse events of decentralized, ambulatory drug-resistant TB (DR-TB) among a high proportion of rifampicin monoresistant TB patients at an outpatient specialized clinic in Johannesburg, South Africa. The study is a retrospective study and differs in two significant ways from previous studies of DR-TB in South Africa.  Firstly, a large proportion of the patients receiving decentralized care have rifampicin mono-resistant TB. All the previous studies 
  • The Costs and Outcomes of Tuberculosis Treatment at Primary Health Care Clinics in an Urban Township, South Africa

    The actual implementation of DOTS across South Africa varies widely. Implementation of DOTS may differ between the intensive phase of treatment (first 2-3 months, with daily injections for the retreatment regimen and a 4-drug fixed combination pill for both first-line regimens) and the continuation phase of treatment (consisting of a daily, 2-drug fixed combination pill). In either phase, the treatment supervisor may be a nurse or counselor at a healthcare facility, a lay healthworker from the 
  • The Costs and Outcomes of Paediatric Tuberculosis Treatment at Primary Health Clinics in Johannesburg, South Africa

    In South Africa, little up-to-date information is available about the costs of providing TB treatment to any population, and no information was found on the costs of providing TB treatment to a paediatric population. Despite the significant burden from paediatric TB, analysis of patient characteristics, contacts, and method of diagnosis is limited. The proposed study aims to begin to fill the information gap by generating descriptive analysis of the cost-outcomes of paediatric treatment for TB 
  • Analysis of Drug Resistant Tuberculosis Population and Outcomes in South Africa, using the Electronic Drug Resistant Tuberculosis Register (EDRWeb)

    The South African Electronic Drug Resistant Tuberculosis Register (EDRWeb) is a national reporting database. We propose a retrospective analysis of this de-identified, established database of routinely reported patient-level data to describe the population and outcomes of drug-resistant TB as recorded within the EDRweb in order to inform treatment guidelines and practice for South Africa. Operational implementation across a broad number of sites is likely to differ from cohorts at 
  • Evaluation of a Standardized Treatment Regimen of Anti-Tuberculosis Drugs for Patients with MDR-TB (STREAM): Economic Evaluation at Sizwe Tropical Diseases Hospital

    Despite the widespread availability of an efficacious and affordable regimen and strategy for managing drug-susceptible tuberculosis (TB), the emergence of multidrug resistant (MDR) TB remains a major challenge for global TB control efforts. In 2010, data from Bangladesh indicated that a nine-month regimen achieves outcomes comparable to those of the existing, 18-24 month, WHO-approved MDR-TB regimen. The primary objective of the STREAM trial is to assess whether the Bangladesh regimen is 
  • Rewards for TB Contact Screening (RECON)

    Because of the high risk of both TB and HIV among the household contacts of TB patients and the importance of early case detection for both diseases and especially for DR-TB, improving TB case finding is a high priority. Recent studies have shown that having healthcare workers make multiple visits to the homes of TB patients in order to screen household contacts is a logistically challenging and resource- intensive strategy, and it is not routinely undertaken in most public sector settings in 
  • Using Routinely Collected Laboratory Data to Characterise Trends in the TB Epidemic

    The overall aim of this study is to harness routinely collected laboratory data to characterize the spatial distribution of tuberculosis in South Africa. In collaboration with partners at the University of the Witwatersrand and the National Health Laboratory Service, we are conducting retrospective analyses of de-identified data to highlight areas with greater burden of TB disease and investigate whether burden is changing over time. Results from this work will be informative for planning for 

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