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 community, a relative, the patient’s employer, an NGO caregiver, another caregiver, a volunteer, or someone else.  The alternative to any one of these supervisors is unsupervised treatment in which the patient is solely responsible, without a supervisor. The objective of this retrospective record review is to determine the cost of treatment for drug-sensitive TB at two public sector primary health care clinics in Johannesburg, South Africa, stratified by treatment outcome and by model of DOTS implementation.