Diverse clinical and social circumstances: developing patient-centred care for DR-TB patients in South Africa.

Journal: Public health action

Volume: 11

Issue: 3

Year of Publication: 

Affiliated Institutions:  Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa. TB Centre, London School of Hygiene & Tropical Medicine, London, UK. Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK. Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa. School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. Livingstone Hospital, Eastern Cape Department of Health, Port Elizabeth, South Africa.

Abstract summary 

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.Thirteen districts across three South African provinces.This descriptive study examined laboratory and healthcare facility records of 194 patients diagnosed with RR-TB in the third quarter of 2016.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.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.

Authors & Co-authors:  Mitrani L L Dickson-Hall L L Le Roux S S Hill J J Loveday M M Grant A D AD Kielmann K K Mlisana K K Moshabela M M Nicol M P MP Black J J Cox H H

Study Outcome 

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Statistics
Citations :  World Health Organization Global tuberculosis report, 2019. Geneva, Switzerland: WHO; 2019.
Authors :  12
Identifiers
Doi : 10.5588/pha.20.0083
SSN : 2220-8372
Study Population
Male,Female
Mesh Terms
Other Terms
health systems;integrated care;patient complexity
Study Design
Descriptive Study,Cross Sectional Study
Study Approach
Country of Study
South Africa
Publication Country
France