Mapping Psychosocial Determinants of Loss to Follow-Up Among Drug-resistant Tuberculosis Patients in South Africa: A Scoping Review Protocol

AbstractBackground: Drug-resistant tuberculosis (DR-TB) in South Africa continues to threaten TB control, with loss to follow-up (LTFU) at both pretreatment (diagnosed but not initiated) and on-treatment stages undermining program success. Psychosocial determinants such as stigma, depression and anxiety, alcohol and substance use, and social and family support are frequently implicated, yet evidence is scattered across disciplines, uses heterogeneous definitions and tools, and is seldom synthesized for policy and implementation.Materials and Method: This scoping review aims to systematically map psychosocial determinants associated with pretreatment and on-treatment LTFU among people with DR-TB in South Africa, describe how these determinants and LTFU are defined and measured, identify contextual modifiers (e.g., HIV status, sex/age, province, urban–rural setting, decentralization, regimen era), and highlight evidence gaps and practical leverage points for intervention. The review will follow established scoping-review methodology and report per PRISMA-ScR following five steps: (1) defining the research question, (2) search strategy, (3) setting inclusion criteria, (4) extracting data, (5) assessing, summarizing , presenting findings and (6) Consultation. A comprehensive peer-reviewed literature search, including PubMed, Scopus, ScienceDirect, and Google Scholar, will be conducted by two independent reviewers. The review will span over eight weeks, focusing on studies in South Africa published in English language between 2010 and 2025. Article eligibility will be determined using a two-stage screening process with disagreements resolved through consensus and consultation of a third reviewer. The results of this review will be presented as tables, including a narrative synthesis of the findings. No meta-analysis is planned.Conclusion: The review will deliver a policy-ready map of psychosocial risks and promising supports for DR-TB retention in South Africa, informing the design and targeting of patient-support packages and outlining priorities for future evaluation and standardization of LTFU definitions and psychosocial measures.