Loveday M., Padayatchi N., Wallengren K., Roberts J., Brust J.C.M., Ngozo J., Master I., Voce A.
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; Tuberculosis and HIV Investigative Network of KwaZulu-Natal (THINK), Durban, South Africa; Retired from Centres for Disease Control and Prevention, Atlanta, GA, United States; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa; King Dinuzulu Hospital Complex, KwaZulu-Natal Department of Health, Durban, South Africa; Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
Loveday, M., Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Padayatchi, N., Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa; Wallengren, K., Tuberculosis and HIV Investigative Network of KwaZulu-Natal (THINK), Durban, South Africa; Roberts, J., Retired from Centres for Disease Control and Prevention, Atlanta, GA, United States; Brust, J.C.M., Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States; Ngozo, J., KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa; Master, I., King Dinuzulu Hospital Complex, KwaZulu-Natal Department of Health, Durban, South Africa; Voce, A., Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. Methods: In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. Findings: We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. Conclusion: We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines. © 2014 Loveday et al.
article; case study; clinical handover; comparative study; controlled study; data collection method; health care delivery; health care management; health care planning; health care quality; health program; health service; health system integration; health systems performance; human; Human immunodeficiency virus infection; interview; mixed infection; mortality; multidrug resistant tuberculosis; outcome assessment; participant observation; patient care; patient monitoring; performance measurement system; practice guideline; qualitative analysis; quantitative analysis; South Africa; systematic text condensation; treatment failure; antibiotic resistance; antiviral resistance; clinical trial; Coinfection; disease management; health personnel attitude; HIV Infections; multicenter study; multidrug resistance; politics; prospective study; qualitative research; residential care; statistics and numerical data; treatment outcome; Tuberculosis, Multidrug-Resistant; anti human immunodeficiency virus agent; tuberculostatic agent; Anti-HIV Agents; Antitubercular Agents; Attitude of Health Personnel; Catchment Area (Health); Coinfection; Delivery of Health Care; Disease Management; Drug Resistance, Bacterial; Drug Resistance, Multiple; Drug Resistance, Viral; HIV Infections; Humans; Politics; Prospective Studies; Qualitative Research; Quality Indicators, Health Care; South Africa; Treatment Outcome; Tuberculosis, Multidrug-Resistant
National Institute of Allergy and Infectious Diseases; K23AI083088, NIAID, National Institute of Allergy and Infectious Diseases