Policy analysis: Key milestones in MDR-TB management over the past decade in South Africa

Background Significant strides have been made globally and in South Africa (SA) in the policy and biomedical management of multidrug-resistant tuberculosis (MDR-TB). However, MDR-TB remains a significant public health threat. Aim This policy content analysis aims to explore the key milestones in MDR-TB management in SA and globally over the last decade, 2013-2023, to identify gaps and opportunities for improvement. Setting This review focussed on global and South African national MDR-TB policies since SA is on all three World Health Organization (WHO) watch lists for TB, TB/HIV and MDR-TB, despite its significant contributions to policy. Method A policy review and content analysis were conducted of all publicly available SA and WHO drug-resistant TB policies developed between 2013 and 2023. Results Key changes identified were in the areas of new drug development and regimens, care delivery settings, task shifting and, terminology used in the field of drug-resistant TB. Changes in the biomedical sphere predominated in both SA and WHO policies. Conclusion Important biomedical interventions have offered renewed hope for the SA MDR-TB programme. This review highlights that policy translation and implementation in non-biomedical interventions have been slow, sometimes lagging up to 10 years behind an intervention being recommended. This article recommends equal weight be placed on non-biomedical interventions and that these policy translations occur at a more rapid speed to positively impact the dire public health consequences of MDR-TB. Contribution Insights offered through this policy review may contribute to policy development, translation and implementation towards improving MDR-TB outcomes in SA.