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 bacilli (AFB) smear‐negative MDR‐TB patients without extensive drug resistance and who are otherwise ambulatory be initiated and treated through an outpatient model of care at a decentralized unit. Additionally, patients who do not yet have confirmed MDR-TB (i.e. those who have rifampicin (RIF) resistance on an Xpert MTB/RIF but have not yet had the follow-up isoniazid (INH) testing through line probe assay (LPA) or drug-sensitivity testing on liquid culture (DST)) are to be initiated on treatment at decentralized outpatient facilities.