L Mitrani1, L Dickson-Hall1, S Le Roux1, J Hill2, M Loveday3,4, A D Grant2,5, K Kielmann6, K Mlisana7, M Moshabela8, M P Nicol1,9,10, J Black11,12, H Cox1,9. 1. Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa. 2. TB Centre, London School of Hygiene & Tropical Medicine, London, UK. 3. Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. 4. Centre for the AIDS Programme of Research in South Africa, Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa. 5. Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences and School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 6. Institute for Global Health and Development, Queen Margaret University, Edinburgh, Scotland, UK. 7. Department of Medical Microbiology, University of KwaZulu-Natal, Durban, South Africa. 8. School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. 9. Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa. 10. School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia. 11. Livingstone Hospital, Eastern Cape Department of Health, Port Elizabeth, South Africa. 12. Department of Medicine, University of Cape Town, Cape Town, 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.
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.
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