title: Low treatment initiation rates among multidrug-resistant tuberculosis patients in Gauteng, South Africa, 2011.
abstract: METHODS
  Gauteng, South Africa.
  
  
  OBJECTIVE
  To determine treatment uptake among newly diagnosed multidrug-resistant tuberculosis (MDR-TB) patients and risk markers for non-initiation of treatment.
  
  
  METHODS
  A cross-sectional study was conducted including all newly diagnosed MDR-TB patients in Gauteng Province, South Africa, in 2011. Socio-demographic and clinical characteristics of those who attended Sizwe Hospital, the designated MDR-TB hospital, were extracted from their medical records. District health offices provided data on patients not seen at Sizwe Hospital. Univariate and multivariate analysis were used to determine risk markers for non-initiation of treatment.
  
  
  RESULTS
  Of the 942 newly diagnosed MDR-TB patients in Gauteng, only 593 (63%) initiated treatment. Of these, 70 (11.8%) did not maintain treatment up to the fourth month. Among the 349 (37%) who did not initiate treatment, 31.2% died and 46.4% could not be accounted for. Referral for laboratory diagnosis from hospitals, health district of the laboratory diagnosis, human immunodeficiency virus infection and place of residence were independently associated with non-initiation of MDR-TB treatment.
  
  
  CONCLUSIONS
  Untreated patients continue to transmit MDR-TB in the community. These study findings highlight the need to identify and target the causes of non-initiation of treatment in specific settings.
authors.affiliation: South African Field Epidemiology and Laboratory Training Programme, National Institute for Communicable Diseases, Sandringham, South Africa. jodimegwu@yahoo.com
authors.forename: J I
authors.initials: JI
authors.lastname: Ebonwu
authors.forename: K S
authors.initials: KS
authors.lastname: Tint
authors.forename: C
authors.initials: C
authors.lastname: Ihekweazu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents