Diverse Clinical and Social Circumstances: Developing Patient-centred Care for DR-TB Patients in South Africa

Overview

Journal Public Health Action

Date 2021 Sep 27

PMID 34567987

Citations 5

Authors

L Mitrani

L Dickson-Hall

S Le Roux

J Hill

M Loveday

A D Grant

K Kielmann

K Mlisana

M Moshabela

M P Nicol

J Black

H Cox

Affiliations

Soon will be listed here.

Abstract

Objective: To describe the medical, socio-economic and geographical profiles of patients with rifampicin-resistant TB (RR-TB) and the implications for the provision of patient-centred care.

Setting: Thirteen districts across three South African provinces.

Design: This descriptive study examined laboratory and healthcare facility records of 194 patients diagnosed with RR-TB in the third quarter of 2016.

Results: The median age was 35 years; 120/194 (62%) of patients were male. Previous TB treatment was documented in 122/194 (63%) patients and 56/194 (29%) had a record of fluoroquinolone and/or second-line injectable resistance. Of 134 (69%) HIV-positive patients, viral loads were available for 68/134 (51%) (36/68 [53%] had viral loads of >1000 copies/ml) and CD4 counts were available for 92/134 (69%) (20/92 [22%] had CD4 <50 cells/mm). Patients presented with varying other comorbidities, including hypertension (13/194, 7%) and mental health conditions (11/194, 6%). Of 194 patients, 44 (23%) were reported to be employed. Other socio-economic challenges included substance abuse (17/194, 9%) and ill family members (17/194, 9%). Respectively 13% and 42% of patients were estimated to travel more than 20 km to reach their diagnosing and treatment-initiating healthcare facility.

Conclusions: RR-TB patients had diverse medical and social challenges highlighting the need for integrated, differentiated and patient-centred healthcare to better address specific needs and underlying vulnerabilities of individual patients.

Citing Articles

Travel distance to rifampicin-resistant tuberculosis treatment and its impact on loss to follow-up: the importance of continued RR-TB treatment decentralization in South Africa.

McNabb K, Bergman A, Patil A, Lowensen K, Mthimkhulu N, Budhathoki C BMC Public Health. 2024; 24(1):578.

PMID: 38389038 PMC: 10885440. DOI: 10.1186/s12889-024-17924-0.

Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study.

Dickson L, Le Roux S, Mitrani L, Hill J, Jassat W, Cox H BMJ Open. 2023; 13(11):e067121.

PMID: 37977868 PMC: 10660906. DOI: 10.1136/bmjopen-2022-067121.

Time-to-Treatment Initiation in a Decentralised Community-Care Model of Drug-Resistant Tuberculosis Management in the OR Tambo District Municipality of South Africa.

Iruedo J, Pather M Int J Environ Res Public Health. 2023; 20(14).

PMID: 37510655 PMC: 10379855. DOI: 10.3390/ijerph20146423.

Prevalence of cardiovascular risk factors in active tuberculosis in Africa: a systematic review and meta-analysis.

Baluku J, Ronald O, Bagasha P, Okello E, Bongomin F Sci Rep. 2022; 12(1):16354.

PMID: 36175540 PMC: 9523035. DOI: 10.1038/s41598-022-20833-0.

A qualitative study of patients and healthcare workers' experiences and perceptions to inform a better understanding of gaps in care for pre-discharged tuberculosis patients in Cape Town, South Africa.

Kallon I, Colvin C, Trafford Z BMC Health Serv Res. 2022; 22(1):128.

PMID: 35093053 PMC: 8801106. DOI: 10.1186/s12913-022-07540-2.

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