Abstract:
BACKGROUND : To assess the quality and completeness of treatment and outcome data in the electronic tuberculosis
(TB) and antiretroviral treatment (ART) registers in drug-resistant (DR-) TB patients at three treatment facilities in
South Africa.
METHODS : We did a retrospective cohort study using routinely-collected data from DR-TB registers of rifampicin
resistant adults (≥18 years old), on ART, initiating DR-TB treatment between January 2012 and December 2013. We
linked patient information from the DR-TB register to the ART register using patient identifiers and an algorithm
based on string edit distance and date of birth. We describe data gaps and discrepancies found.
RESULTS : Overall, 2852 DR-TB patients met our inclusion criteria based on the DR-TB register data, and of these, 1685
(59%) could be matched to the ART registers. An additional 253 patients from the DR-TB registers were found in
the ART registers, having initiated ART, despite the DR-TB register indicating that they were not on ART (or this data
was missing). 11% of matched patients did not have TB treatment status recorded in the ART register despite being
recorded as being on TB treatment in the DR-TB register, and 78% did not have an ART start date recorded in DRTB
register despite being on ART treatment as per the ART register. 11% of matched patients had a death recorded
in one register but not the other, and of those with death recorded in both, 15% of dates differed by > 1 month.
CONCLUSIONS : The underreporting of death and the lack of ART or TB status in the electronic DR-TB and ART
registers could negatively impact monitoring efforts by downplaying the state of the TB/HIV epidemic. Improved
recording of these data sources, and data integration across systems, could improve the accuracy of reporting for
the national HIV/ART and TB programs.
