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Centre for Tuberculosis
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Reference: SA TB DRS (2012-14)
12 July 2016
South African Tuberculosis Drug Resistance Survey (2012-14)
South Africa ranks among the top three countries contributing to the most cases of people with tuberculosis
(TB) per 100 000 population globally. Although TB is on the decline in South Africa, the burden still remains
unacceptably high and it is the leading cause of death due to infectious diseases in South Africa with 450 000
new cases and 24 000 deaths having been estimated to have occurred in 2014 alone. Multi-drug resistant TB
(MDR-TB) a type of TB resistant to the two main antibiotics used for treatment has emerged as a concern.
MDR-TB is more difficult to treat, with only 50% of treated cases being cured, despite it costing 100 times
more than treatment of drug-susceptible TB. Following the outbreak of extensively drug resistant TB in KwaZulu Natal and subsequent reports of increasing numbers in other parts of the country, the National
Department of Health commissioned the National Institute for Communicable Diseases (NICD) to conduct a
second survey of MDR-TB in South Africa.
MDR-TB surveys are conducted periodically to estimate the burden of the disease: the Medical Research
Council conducted the first survey in South Africa in 2001-2. The second South African Tuberculosis Drug
Resistance Survey (2012-2014) was undertaken by the NICD to determine the prevalence of MDR-TB and
other types of drug resistant TB in all nine provinces and assess changes relative to the previous survey more
than 10 years prior. The survey enrolled participants in 442 randomly selected health facilities across the
country with just over 200 000 people screened.
Findings from the current survey confirmed that the prevalence of multi-drug resistant TB (MDR-TB) is stable
(2.8%) compared to the previous survey conducted in 2001-2 (2.9%); and is lower relative to that reported
globally (7.7%). Nevertheless, this represents that 3 out of every 100 TB cases in South Africa are drugresistant. It is, however, important to note that drug-susceptible TB cases account for the majority TB cases;
and ensuring that these cases are timeously identified and effectively managed are critical in preventing MDRTB. Provincial variation of MDR-TB prevalence was observed, with the highest prevalence observed in
Mpumalanga (5.1%), which was also the case in the previous survey. An assessment of risk factors and the TB
response program in Mpumalanga has been initiated to identify possible contributory issues and inform a
response plan in this province.
Although MDR-TB has remained stable nationally, there has been an almost doubling of resistance to
rifampicin (1.8% to 3.4%), the main drug for TB treatment, in patients without any previous history of TB
treatment. This indicates that these cases were infected by untreated close contacts with drug resistant TB.
Another finding from the survey was a high prevalence of second line drug resistance among those cases with
MDR-TB. Among those with MDR-TB, 1 in 20 had extensively drug resistant TB (XDR-TB), which is an
even more resistant type of TB). It does not appear to be a generalized problem, but restricted to pockets
within the country. Work is currently underway at the NICD to map these hotspot areas, so that interventions
can be targeted for greatest impact. This also partly explains the poor outcomes observed in MDR-TB
patients, among whom more than 25% had some form of additional resistance to currently used antibiotics.
Early detection and improved regimens will be needed to improve outcomes in these cases, including
warranting a relook at the current anti-TB regimens used in these cases.
Early diagnosis and treatment is still the mainstay of control of TB control and preventing MDR-TB. South
Africa has introduced the latest technology (Gene Xpert) that can rapidly detect drug resistance; utilization
needs to be closely monitored and diagnosed patients need to be started on treatment as quickly as possible.
This study will help inform the allocation of resources and expertise to respond to the TB epidemic in South
Africa’s response.
For more information contact:
Nombuso Shabalala (011) 555 0545 / 082 886 4238
[email protected]
The report and executive summary are available at www.nicd.ac.za