The South African Tuberculosis Drug-Resistant Survey (DRS) 2012-14 sought to determine the prevalence of multidrug-resistant TB (MDRTB) and other TB drug resistance in South Africa, enrolling participants from 464 randomly selected facilities in all nine provinces of the country. It was the largest TB DRS conducted with over 200 000 persons screened, over 5 000 000 data elements double-captured and more than 300 000 primary survey laboratory tests completed, including 100 000 individual drug susceptibility tests (against first and second-line drugs). Compared with the previous survey, the culture positivity rate was lower and in line with current recommendations, suggesting that patients are presenting earlier than before and that they are being appropriately screened… Click here to read more

The unique design of this survey incorporates the recruitment of presumptive cases rather than smear-positive cases only, allowing assessment of the drug resistance burden inclusive of both smear-positive and smear-negative patients – an important issue for high HIV/AIDS burdened settings like South Africa. This was successfully achieved and the overall smear positivity rate among culture-confirmed cases was 55% nationally with a range of 45%–68% provincially. Among culture-positive cases, the percentage with a history of prior treatment was 22% nationally with the highest being in the Western Cape, at 35%. The HIV co-infection rate was 63.2% with the highest observed in Mpumalanga (76.8%). An additional difference compared with the previous survey was the testing of all culture-confirmed cases for a full range of drugs, including second-line agents. This data will be important in informing future drug regimens, both for novel regimens being tested among rifampicin susceptible cases, and for RR TB. The latter has emerged as an important concern with poor outcomes, especially in pre-XDR and XDR TB cases, but there is renewed optimism with the introduction of new drugs that could be combined with drugs to which lower levels of resistance, based on the survey findings, are present. The final report will be used to guide appropriate interventions.