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.