In a new qualitative study, GenPath Africa colleagues Caitlin October, Anja Reuters, Nabila Ismail, Emilyn Costa Conceição, Susanne Tönsing, Rob Warren, and Fanie Malherbe from Stellenbosch University, along with Vincent Rennie and Annelies Van Rie from the University of Antwerp, investigated how healthcare workers navigate the complex process of managing people exposed to drug-resistant tuberculosis (DR-TB). Their research explores the significant gap between official clinical guidelines and the practical realities of providing life-saving care in resource-constrained communities.

What is this publication about?

As part of the PARR-TB project, researchers interviewed healthcare workers to understand the decision-making processes, challenges, and contextual factors that will influence adoption and use of WGS-informed clinical decision support. Researchers conducted in-depth interviews with 22 healthcare workers—including medical officers, nurses, and community workers—at 11 public health facilities in the Western Cape, South Africa. Using the Situated Clinical Decision-Making Framework (SCDMF), the team examined how clinical and social factors influence how these workers decide on TB preventive therapy (TPT). The study identified four major interrelated barriers: overcrowded living conditions, the impact of stigma and non-disclosure of TB status, delayed or incomplete laboratory results, and a lack of formal training on current DR-TB post-exposure management.

Why is this important?

Effective post-exposure management is a critical pillar for controlling the spread of DR-TB, which is more complex and costly to treat than drug-sensitive versions of the disease. However, standard guidelines often lack the operational detail needed for frontline clinicians to implement them effectively in the real world. The study reveals that due to systemic constraints and clinical uncertainty, healthcare workers must often rely on their experiential knowledge, clinical intuition, and peer consultation to make decisions, such as when they must initiate treatment for a patient before their full drug-resistance profile is confirmed. Understanding these adaptive practices is essential for developing more realistic health policies and decision-support tools.

How can this make a difference?

By highlighting that clinical decisions are shaped by environment and system limitations rather than just a lack of knowledge, this research advocates for interventions that restore the conditions necessary for effective care. The findings suggest that strengthening diagnostic turnaround times, providing formal training, and developing context-sensitive strategies to address TB-related stigma are critical steps. Restoring these conditions will support consistent, evidence-based management of people exposed to DR-TB, ultimately improving patient outcomes and strengthening efforts to prevent the further spread of drug-resistant disease.

C.D. October, B. Beko, A. Reuter, V. Rennie, N. Ismail, E.C. Conceicao, S. Tonsing, R.M. Warren, S.T. Malherbe, A. Van Rie, L. Viljoen. "Real-world decision-making for post-exposure management of drug-resistant TB." IJTLD Open 2026; 3(6): 403–408. doi:10.5588/ijtldopen.26.0125.