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

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/mm3). 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.

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

“…Finally, in terms of clinical implications, improvements in PCC for TB patients may be especially useful in minimising rifampicin-resistant TB [ 35 ]. TB patients have complex and multi-faceted needs and challenges that include significant socio-economic and medical problems and require a nuanced approach [ 35 ].…”

“…Finally, in terms of clinical implications, improvements in PCC for TB patients may be especially useful in minimising rifampicin-resistant TB [ 35 ]. TB patients have complex and multi-faceted needs and challenges that include significant socio-economic and medical problems and require a nuanced approach [ 35 ]. Some studies have demonstrated that improvements in patient-health provider relationships can enhance health outcomes in patients with a wide variety of health problems [ 36 , 37 ].…”

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

“…However, Mburu et al 56 used HbA1c of > 6.0% as the cut-off for defining DM in Kenya. Among patients with DRTB, the pooled prevalence was also 7.0% (95% CI 2.0-12.0, I 2 = 97.6%, p < 0.001) [35][36][37]39,42,44,48,57 .…”

“…The prevalence of hypertension ranged from 0.3% in Mozambique 54 to 37.0% in South Africa 59 . The prevalence in DRTB was 13.0% (95% CI 4.0-22.0, I 2 = 97.3%, p < 0.001) in six studies 37,42,44,48,57,60 . East Africa had the highest pooled prevalence of hypertension at 22.0% (95% CI 12.0-33.0, I 2 = 96.5%, p < 0.001) followed by Southern Africa at 14.0% (95% CI 8.0-19.0, I 2 = 99.3%, p < 0.001) and West Africa at 6.0% (95% CI 1.0-11.0, I 2 = 94.4%, p < 0.001).…”

“…The prevalence ranged from 3.3% in South Africa 46 to 97.8% in another study from South Africa 47 . In DRTB, the pooled prevalence of any current use was 27.0% (95% CI 16.0-38.0, I 2 = 98.6%, p < 0.001) 35,36,38,40,42,43,46,[48][49][50] . Across the regions, the pooled prevalence of any current alcohol use was highest in East Africa but similar in other regions; that is, 32.0% (95% CI 24.0-40.0, I 2 = 98.8%, p < 0.001) in East Africa, 29.0% (95% CI 21.0-36.0, I 2 = 99.7%, p < 0.001) in Southern Africa, and 29.0% (95% CI 15.0-43.0, I 2 = 99.6%, p < 0.001) in West Africa.…”