Clinical and Microbiological Characteristics Associated with Treatment Outcomes Among Rifampicin-Resistant Tuberculosis Patients in Limpopo Province.

BACKGROUND

Drug-resistant tuberculosis (DR-TB) remains a major public health concern in South Africa, particularly in rural provinces such as Limpopo, where access to specialized care is limited. High HIV prevalence, population mobility, and constrained diagnostic capacity further complicate disease control. Province-specific data are essential to guide targeted interventions; however, factors associated with treatment outcomes in rural settings remain poorly characterized.

METHODS

A retrospective cohort study was conducted using routinely collected laboratory and programmatic data. All laboratory-confirmed DR-TB cases recorded in Limpopo Province between 2023 and 2025 were included. Microbiological data were obtained from the National Health Laboratory Service, while demographic, clinical, and treatment outcome data were extracted from the Electronic Drug-Resistant Tuberculosis Register. Descriptive statistics summarized patient characteristics. Associations with treatment outcomes were assessed using chi-square tests and multivariable logistic regression. Kaplan-Meier analysis compared survival by HIV status.

RESULTS

A total of 86 RR-TB patients were included. Most were aged 25-44 years (65.1%), with males comprising 70.9%, and 55.8% were HIV co-infected. Favourable treatment outcomes were observed in 62 (71.4%) patients, while 12 (14.3%) experienced unfavourable outcomes and 12 (14.3%) remained on treatment. In multivariable analysis, younger age (15-24 years) (AOR = 9.97, 95% CI: 1.48-67.33) and smear-negative status (AOR = 39.62, 95% CI: 3.33-471.83) were independently associated with unfavourable outcomes, whereas HIV status was not significant after adjustment. Kaplan-Meier analysis showed poorer survival among HIV-positive patients (log-rank p = 0.002), although this was not retained in the adjusted model.

CONCLUSION

DR-TB in Limpopo is characterized by a high burden of TB-HIV co-infection and rifampicin resistance. Clinical factors, rather than resistance patterns, were key determinants of unfavourable outcomes. Strengthening integrated TB-HIV services, improving early diagnosis, and expanding drug susceptibility testing are critical to improving outcomes.