Mojisola Clara Hosu

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health challenge in resource-constrained settings. This study compared treatment outcomes between shorter and longer/conventional MDR-TB regimens in the rural Eastern Cape, South Africa. Methods: This retrospective cohort study analyzed records of 233 patients treated for MDR-TB between January 2020 and December 2024 in O.R. Tambo District Municipality. Treatment success was defined as cure or treatment completion. Multivariable logistic regression assessed the association between regimen and treatment success, adjusting for age, sex, HIV status, and previous TB treatment. Results: The mean age was 37.9 ± 14.1 years, and 60.1% were male. Most patients received a shorter regimen (89.7%), while 10.3% received a longer/conventional regimen. Overall, 45.1% were cured and 21.0% completed treatment, yielding a 66.1% treatment success rate. Treatment success was higher with shorter than longer/conventional regimens (69.4% vs. 37.5%; p = 0.003). In multivariable analysis (n = 224), the longer/conventional regimen was associated with lower odds of treatment success (aOR 0.26, 95% CI 0.10–0.66; p = 0.005). Increasing age was also associated with lower odds of success (aOR 0.96 per year, 95% CI 0.94–0.98; p < 0.001). Adverse-event data were substantially incomplete. Conclusions: Shorter regimens were associated with higher treatment success; however, non-randomized treatment allocation, regimen-group imbalance, residual confounding, and incomplete routine data preclude causal interpretation. Prospective studies and strengthened clinical data systems are needed to evaluate the effectiveness and safety of regimens in rural settings.

Background: Tuberculosis (TB) remains a major global health concern, particularly in low- and middle-income countries, due to its high prevalence, mortality, and economic impact. The emergence of drug-resistant tuberculosis (DR-TB) has intensified this burden, posing significant challenges to disease control and management. Understanding the epidemiology of DR-TB is crucial for improving prevention strategies, guiding treatment interventions, and informing public health policies aimed at reducing its spread and impact. Methods: A retrospective cohort study was conducted using medical records of patients diagnosed with DR-TB between January 2020 and December 2024 at decentralized DR-TB clinics in the O.R. Tambo District Municipality, Eastern Cape, South Africa. Treatment outcomes were collected from available records through August 2025. Data on demographic, clinical, and treatment outcome variables were collected using a structured abstraction tool. Data was analyzed using SPSS version 30 (IBM Corp., Armonk, NY, USA). Results: A total of 385 participants were included in the study, with a mean age of 38.6 years. Males accounted for 62.3% of cases. Most participants (94.3%) resided in rural areas, and 62% were HIV-coinfected. Rifampicin-resistant TB was the most common type (51%), followed by MDR-TB (38%). A significant association was observed between age and HIV status (p = 0.001). Treatment outcomes showed that 40.8% of patients were cured, while 11.7% died, with mortality highest among older and HIV-positive patients. Comorbidities reported included hypertension and diabetes mellitus. Conclusions: Most patients included in this facility-based cohort were males, aged 25–39 years, rural residents, living with HIV, with suboptimal treatment outcomes and a substantial comorbidity burden. Strengthened integrated TB/HIV care, early diagnosis, and targeted interventions are needed to improve DR-TB outcomes in this setting.

Latent tuberculosis infection (LTBI) remains an under-recognized component of tuberculosis (TB) prevention in South Africa despite its potential to progress to active disease and contribute to ongoing transmission. This study assessed community awareness, perceptions of LTBI treatment, and perceived barriers to screening and care among adults in the King Sabata Dalindyebo Local Municipality, Eastern Cape, South Africa. A community-based cross-sectional survey was conducted using a structured interviewer-administered questionnaire assessing LTBI awareness, perceived risk of progression, understanding of the consequences of untreated LTBI, attitudes towards screening and treatment, and perceived barriers to care. Data were analysed using descriptive statistics, chi-square tests, correlation analysis, and multivariable logistic regression to identify independent predictors of LTBI knowledge. LTBI awareness varied significantly across age groups, with the highest awareness observed among participants aged 20–29 years and lower awareness among older adults. Although concern about progression to active TB was high, knowledge of the consequences of untreated LTBI and uptake of preventive treatment remained limited. Lack of awareness was the most frequently reported barrier to LTBI screening and treatment, followed by fear of medication side effects and stigma. Greater knowledge of LTBI was associated with fewer informational barriers, while lower educational attainment independently predicted poor LTBI knowledge. These findings demonstrate important gaps between awareness, perceived risk, and engagement in preventive care. Strengthening community education, improving access to LTBI information, and addressing informational barriers may enhance screening uptake and preventive treatment in rural, high-burden communities, thereby supporting tuberculosis elimination efforts in South Africa.

Background: Mixed-strain Mycobacterium tuberculosis ( M. tuberculosis; Mtb) infections and heteroresistance are increasingly recognized as under-detected contributors to drug resistance dynamics. In high-burden rural settings such as the Eastern Cape, these genomic features may reflect both within-host diversity and ongoing transmission. However, their epidemiological and clinical implications remain incompletely understood, particularly in contexts with high HIV co-infection. Methods: We conducted an exploratory whole-genome sequencing (WGS) analysis of 28 drug-resistant M. tuberculosis isolates obtained through routine diagnostic workflows. Mixed-strain candidacy was defined using a composite genomic criterion, including multi-lineage assignments, ≥2 heteroallelic variants [allele frequency (AF): 0.10–0.90], or heteroresistance across multiple drug classes. A Random Forest (RF) model with Leave-One-Out Cross-Validation (LOOCV) was used as a feature-prioritization tool to identify genomic characteristics associated with mixed-strain candidacy. Given the limited sample size, analyses were designed to generate hypotheses rather than support causal inference. Clinical and epidemiological metadata, including HIV status and treatment outcomes, were not available. Results: Lineage 4 (46%) and Lineage 2 (43%) predominated, with 10.7% of isolates classified as probable mixed-strain candidates. Heteroallelic variants were most frequently observed in fabG1/inhA and rpoB , with a median AF of 0.22, consistent with subclonal diversity and possible within-host microevolution. Additional heteroallelic variants were identified in non-resistance-associated genes, suggesting broader genomic heterogeneity. The RF model demonstrated high discriminatory performance (AUC = 1.00), although this likely reflects the small sample size and should be interpreted cautiously. Feature importance analysis identified heteroresistance burden as the most prominent predictor of mixed-strain candidacy. Conclusion: This pilot study provides preliminary genomic evidence of mixed-strain infection and heteroresistance in a high-burden rural setting. While these findings highlight the potential role of subclonal diversity in shaping resistance patterns, their clinical and epidemiological relevance remains uncertain due to the absence of patient-level data and limited sample size. Future studies integrating genomic, clinical, and epidemiological data in larger cohorts and incorporating benchmarking against established tools are required to validate these findings and clarify their implications for tuberculosis control.

Background/Objectives: The growing burden of multidrug-resistant tuberculosis (MDR-TB), driven by poor treatment adherence and limited diagnostic access, has complicated disease control efforts. The recent introduction of shorter, less toxic regimens offers renewed hope for improving treatment outcomes. This study aimed to evaluate shorter versus conventional treatment regimens for MDR-TB. Methods: This retrospective cross-sectional study analyzed medical records of MDR-TB patients treated between January 2020 and December 2024 at selected rural healthcare facilities within the OR Tambo District Municipality, Eastern Cape Province. Data were analyzed using SPSS version 29, with p-values < 0.05 considered statistically significant. Results: A total of 288 patients who received either a shorter or a conventional MDR-TB treatment regimen were included, with 235 (81.8%) receiving a shorter regimen and 53 (18.2%) a conventional regimen. There was no significant association between regimen type and treatment success (p = 0.600). Sociodemographic factors, including gender and younger age, influenced outcomes (p = 0.002; 0.004, respectively), and patients with regular income achieved higher success than those on disability grants (p = 0.004). Adverse drug reactions occurred in 38% of patients and were strongly associated with poor outcomes (p < 0.001). Conclusions: Short and conventional MDR-TB regimens achieved comparable treatment outcomes, suggesting that shorter regimens may provide an effective alternative to conventional treatment while reducing treatment duration and patient burden. These findings support the continued use of short regimens in eligible patients and highlight the need for further studies to assess long-term outcomes and programmatic effectiveness.

Background: Infection prevention and control (IPC) programs are essential for reducing healthcare-associated infections (HAIs), improving patient safety, and strengthening health systems. In low-resource settings, inadequate IPC capacity remains a major challenge, particularly at primary healthcare facilities that serve as the first point of contact in the health system. This study assessed IPC practices and capacity in healthcare facilities in the O.R. Tambo District Municipality using the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF). Method: A cross-sectional descriptive study was conducted at primary healthcare facilities in the O.R. Tambo District Municipality. Eighteen facilities were targeted for participation; 13 consented, yielding a response rate of 72.2%. Data were collected using the WHO IPCAF tool, which assesses eight core IPC components. Descriptive statistics summarized facility characteristics, IPCAF scores, and IPC capacity levels. Result: Most facilities [69.2% (95% CI: 42.3–88.6%, n = 9)] were classified as intermediate IPC level, while 15.4% (95% CI: 3.3–40.9%, n = 2) were inadequate, and 7.7% (95% CI: 0.8–30.7%, n = 1) each were categorized as basic and advanced. The overall median IPCAF score was 452.5 (IQR: 425.0–471.0), indicating intermediate IPC capacity. Higher median scores were observed for IPC programs, IPC guidelines, and the built environment, materials, and equipment domains, whereas HAI surveillance had the lowest median score. IPC education and training, as well as workload, staffing, and bed occupancy, scored below 50. All facilities had an IPC program in place; however, only 46.2% had clearly defined objectives and annual activity plans. IPC committees were present in 76.9% of facilities, and senior leadership participation was reported in 92.3%. Institutional budgetary support for IPC was available in only 15.4% of facilities. Conclusion: Healthcare facilities in the O.R. Tambo District Municipality predominantly had intermediate IPC capacity, with notable gaps in HAI surveillance, staffing, training, and institutional financial support. Strengthening these areas is essential to improve IPC capacity and enhance patient safety in resource-limited healthcare settings.

Background: Tuberculosis (TB) remains a major global health concern, particularly in low- and middle-income countries, due to its high prevalence, mortality, and economic impact. The emergence of drug-resistant tuberculosis (DR-TB) has intensified this burden, posing significant challenges to disease control and management. Understanding the epidemiology of DR-TB is crucial for improving prevention strategies, guiding treatment interventions, and informing public health policies aimed at reducing its spread and impact. Methods: A retrospective cross-sectional study was conducted using medical records of patients diagnosed with DR-TB between January 2020 and December 2024 at DR-TB Clinics in the O.R. Tambo District Municipality, Eastern Cape, South Africa. Data on demographic, clinical, and treatment outcome variables were collected using a structured abstraction tool. Data was analyzed using SPSS. Results: A total of 385 participants were included in the study, with a mean age of 38.6 years. Males accounted for 62.3% of cases. Most participants (94.3%) resided in rural areas, and 62% were HIV-coinfected. Rifampicin-resistant TB was the most common type (51%), followed by MDR-TB (38%). A significant association was observed between age and HIV status (p = 0.001). Treatment outcomes showed that 40.8% of patients were cured, while 11.7% died, with mortality highest among older and HIV-positive patients. Comorbidities reported included hypertension and diabetes mellitus. Conclusions: DR-TB in O.R. Tambo District disproportionately affects young adults, males, and HIV-positive individuals, with suboptimal treatment outcomes and a substantial comorbidity burden. Strengthened integrated TB/HIV care, early diagnosis, and targeted rural interventions are needed to improve DR-TB outcomes in this setting.

Background: Prostate cancer remains a major cause of cancer-related morbidity and mortality among men worldwide. Limited access to oncology services contributes to late presentation, delayed diagnosis, and treatment. This study describes the clinicopathological profile of prostate cancer and identifies factors associated with disease severity at presentation in an Eastern Cape population. Methods: A retrospective cross-sectional study was conducted among men diagnosed with prostate cancer at a tertiary hospital between 2014 and 2024. Demographic, clinical, and pathological data were extracted. Descriptive analyses were performed, and multivariable logistic regression was used to identify independent predictors of advanced disease. Results: The study included 202 patients with a mean age of 67.2 years. Thirty-four (16.8%) reported a family history of prostate cancer, and 62.4% had never undergone PSA screening before diagnosis. Elevated PSA levels were common (60.4%), and more than half of patients presented with advanced disease (54.5%). High-risk and very high-risk disease were identified in 44.1% and 21.3% of patients, respectively. Lack of prior PSA screening was independently associated with high-risk disease (aOR 2.4, 95% CI 1.1–5.0), advanced stage at presentation (aOR 2.4, 95% CI 1.2–4.8), and PSA > 20 ng/mL. Conclusions: There is a high burden of late-stage, high-risk prostate cancer at presentation. These findings highlight ongoing challenges in early detection and emphasize the need for improved awareness, screening, and referral pathways to improve outcomes.

Background: The global burden of drug-resistant Mycobacterium tuberculosis continues to threaten tuberculosis control efforts, largely due to the emergence and transmission of resistance-associated genetic mutations. Molecular epidemiology provides critical insights into mutation profiles and resistance associations, yet the interplay among key mutations and their contributions to complex resistance patterns remains poorly understood, particularly in high-burden settings. Methods: A retrospective, cross-sectional, laboratory-based design was used to analyze 111 phenotypically confirmed drug-resistant isolates. Molecular drug susceptibility testing (DST) for first- and second-line anti-tuberculosis drugs was performed at the National Health Laboratory Service (NHLS) TB reference laboratory. Drug-resistance profiles were classified according to World Health Organization (WHO) definitions. Descriptive and inferential statistical analyses were conducted to determine mutation frequencies, co-occurrence patterns, and associations with resistance profiles. Results: rpoB (D435V 38.7%; S450L 36.0%) and katG (S315T 80.2%) mutations predominated, forming the core molecular basis of MDR-TB, while 15% harbored inhA promoter mutations associated with low-level isoniazid resistance. The most frequent combinations included rpoB S450L with katG S315T and rpoB D435V with katG S315T, consistent with multidrug-resistant tuberculosis (MDR-TB) profiles. Nearly 48% showed dual resistance to fluoroquinolones and second-line injectables. Conclusion: This study highlights the predominance of resistance-associated mutations and their co-occurrence patterns in shaping MDR-TB profiles in the study setting. The observed burden of second-line drug resistance underscores the importance of comprehensive resistance testing. These findings support the use of mutation profiling for rapid diagnosis and informed treatment decisions, while emphasizing the need for ongoing local surveillance to guide TB control efforts.

Background: Drug-resistant tuberculosis (TB) remains a major challenge in high-burden settings, where timely identification of emerging resistance and effective governance responses are critical. While routine molecular diagnostics generate large volumes of resistance-associated mutation data, these outputs are typically used for individual patient management and remain underutilized for population-level surveillance and for the application of clinical governance approaches for improved TB care. Methods: We conducted a retrospective cross-sectional analysis of 1386 molecular diagnostic records for Mycobacterium tuberculosis, collected between March 2021 and December 2024, from 30 health facilities in the King Sabata Dalindyebo (K.S.D.) Local Municipality of Oliver Reginald (O.R.) Tambo District. Resistance-associated mutation proxies were identified for loci associated with isoniazid (katG, inhA), fluoroquinolone (gyrA), and second-line injectable agents (amikacin, kanamycin, and capreomycin) through mutations in the rrs locus. Mutation proxy prevalence was examined overall, by age group, over time, and across facilities. Persistence of resistance detection was assessed using consecutive-month analyses to characterize temporal continuity at the facility level. Results: At least one resistance-associated mutation proxy was detected in 72.7% of the analyzed records. Isoniazid resistance predominated, with katG mutation proxies identified in 52.2% and inhA in 20.2% of cases. Mutation proxies associated with fluoroquinolone and second-line injectable resistance were less frequently observed. Temporal analysis demonstrated variability over the study period, with a general decline in overall mutation proxy prevalence alongside a relative increase in inhA-associated mutations. Substantial heterogeneity in resistance patterns was observed across health facilities, with high-volume sites contributing the greatest absolute burden and selected facilities demonstrating sustained persistence of mutation detection over consecutive months. These findings highlight the magnitude, distribution, and persistence of resistance-associated mutation proxies within routine programmatic data. Conclusions: Routine molecular diagnostic data revealed a substantial and heterogeneous burden of drug-resistant Mycobacterium tuberculosis in K.S.D. Local Municipality, characterized by age-specific patterns, temporal shifts, and sustained facility-level persistence. Beyond descriptive epidemiology, routinely generated mutation proxy data can serve as early-warning indicators of clinical governance stress, signaling emerging pressures on TB care systems when resistance patterns persist or worsen. Interpreting these trends can support more anticipatory clinical governance, strengthen resistance surveillance, and guide prioritized interventions in high-burden, resource-constrained settings.