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Community-based approach to reduce initial loss to follow-up for DR-TB in Nelson Mandela Bay Metro, Eastern Cape Province

Community-based approach to reduce initial loss to follow-up for DR-TB in Nelson Mandela Bay Metro, Eastern Cape Province
Publication date: 
Oct 2018


Rapid identification of TB clients and treatment initiation is a key cornerstone in tuberculosis (TB) control. In 2016, South Africa diagnosed 19,073 drug-resistant TB cases, but only 11,192 of these cases were initiated on appropriate treatment, indicating that 7,881 patients were initially lost to follow-up (ILTFU). Studies in South Africa indicate that 16 per cent to 35 per cent of laboratory confirmed TB cases are not recorded in TB treatment registers (Bristow et al. 2013, Cele et al. 2016). Data from published studies suggests that ILTFU is a significant global problem and that its management is key to the attainment of the End TB Strategy targets


Nelson Mandela Bay Metro district in South Africa’s Eastern Cape province records one of the highest initial lost to follow-up rates (ILTFU) nationally. In response, the USAID Tuberculosis South Africa Project identified this district to pilot an initiative to address the problem.

In partnership with the National Institute of Communicable Disease (NICD), a list of patients with resistance to the drug Rifampicin, referred to as ‘Rif alerts’ were regularly shared with the project. Project staff cross-referenced this list with records in the electronic drug-resistance register (EDR.Web) to establish if all patients on the list were initiated on treatment.  

Lists of clients not recorded as initiated on treatment were handed over to project-funded non-governmental organizations (NGOs) working at community level. These NGOs were tasked with tracking and eventually ensuring the linkage of missing patients to care.


A total of 501 Rif alerts were received between January and September 2017, of which 292 (58%) were found registered in the EDR.Web while an additional 97 (19%) were found in other facilities’ registers. Thus, 112 (22%) were ILTFU patients.  

Through interventions of the USAID TB South Africa Project, 76 of 112 ILTFU patients were tracked, referred and linked to care through project-funded NGOs. Ultimately, of the 501 Rif alerts received from NICD, 465 (93%) were initiated on appropriate treatment and registered in EDR.Web.


Through community-based interventions, two-thirds of ILTFU clients were found and initiated on treatment, which increased the rate of Rif-resistant patients initiated on treatment by 15 per cent and increased the overall Rif resistant patients linked to treatment to 93 per cent. The project established that it is feasible to utilize community partners and resources to reduce ILTFU and improve linkage to TB care.