•
shortening the time to both diagnosis and treatment initiation
•
prioritizing TB infection control in health facilities
•
intensified patient support to ensure adherence.
Of the estimated 391 cases of DR-TB in Khayelitsha in 2008, only 211 (54%) were diagnosed. In such a high DR-TB burden context as this, every TB patient should be tested for drug resistance to achieve the necessary coverage. However current guidelines only recommend testing for DR-TB in patients who were previously treated for TB or who are not responding to TB treatment.
Drug-resistant tuberculosis definitions: In this report, DR-TB refers to infection with Mycobacterium tuberculosis bacteria that are: •
Resistant to the two most important first-line anti-tuberculosis drugs (rifampicin and isoniazid), therefore defined as ‘multidrug resistant’ or MDR
•
Resistant to rifampicin alone, therefore defined as ‘rifampicin mono-resistant’
•
Resistant to rifampicin, isoniazid and two of the most important classes of second-line antituberculosis drugs, namely a fluoroquinolone (such as ofloxacin) and an injectable drug (either amikacin, kanamycin or capreomycin), therefore defined as ‘extensively drug-resistant’ or XDR
•
Resistant to isoniazid and rifampicin (i.e. MDR-TB) as well as either one of the fluoroquinolone drugs OR any of the three injectable second-line anti-TB drugs (amikacin, kanamycin or capreomycin), therefore defined as pre-XDR
Given that all DR-TB patients require second-line anti-tuberculosis treatment and that patients can be infected with strains of TB bacteria having a wide range of possible combinations of resistance to different drugs, we use the term drug resistant TB (DR-TB) throughout this report
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