# Trends and treatment outcomes of drug resistant tuberculosis in Limpopo Province, South Africa (2011–2019): A Retrospective Study

## TL;DR

This study examines drug-resistant tuberculosis treatment outcomes in South Africa's Limpopo Province from 2011 to 2019, finding improved success rates after introducing new drugs like bedaquiline.

## Contribution

The study evaluates the impact of new drug regimens on DR-TB treatment outcomes in a rural, high-burden setting.

## Key findings

- Treatment success increased from 54.1% to 65.3% after introducing bedaquiline.
- XDR-TB had the lowest success rate at 31.3%.
- HIV positivity and age ≥35 were significant predictors of unfavorable outcomes.

## Abstract

Drug-resistant tuberculosis (DR-TB) continues to threaten TB control efforts in South Africa, particularly in resource-limited provinces such as Limpopo. This study evaluated trends in DR-TB and evaluated treatment outcomes and predictors of unfavorable outcomes from 2011 to 2019.

We conducted a retrospective cross-sectional study using data from 3,528 patients with DR-TB recorded in the Limpopo electronic registry (EDRWeb.net). Descriptive statistics characterized the demographics of the patients and the types of resistance. The associations between variables and outcomes were tested using chi-square analysis and binary logistic regression identified independent predictors of unfavorable treatment outcomes. The study period was stratified into pre-bedaquiline (BDQ) (2011–2015) and post-BDQ (2016–2019) eras to assess the impact of treatment.

Rifampicin-resistant TB (RR-TB) (61.7%) and multidrug-resistant TB (MDR-TB) (32.5%) were the most common. Overall, the success of the treatment was 59.0%, increasing from 54.1% in the pre-BDQ era to 65.3% after BDQ. XDR-TB had the lowest success rate (31.3%). In multivariate analysis, male sex (aOR = 1.12; 95% CI: 1.00–1.27), HIV positivity (aOR = 1.28; 95% CI: 1.11–1.47), age ≥ 35 years (aOR = 2.01; 95% CI: 1.08–3.76), and XDR-TB (aOR = 3.05; 95% CI: 1.65–5.65) were independently associated with unfavorable outcome.

Treatment outcomes for DR-TB in Limpopo improved following the introduction of BDQ and shorter all-oral regimens but remain suboptimal, particularly among XDR-TB and HIV co-infected patients. Strengthening TB/HIV integration, expanding access to new drug regimens, and enhancing early diagnosis are essential to improve outcomes in rural high-burden settings.