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 results, tracing, referral, treatment initiation), the time required between steps, and the characteristics of patients are unknown.  There are no estimates available, for example, of the proportion of patients diagnosed with drug-resistant TB who actually initiate appropriate treatment.  It is therefore important to identify how recent policy changes for diagnosis and models of care have affected the proportion initiating and time to initiation of 2nd line TB treatment.