Diverse clinical and social circumstances: Developing patient-centred care for DR-TB patients in South Africa
Le Roux, Sacha
Grant, Alison D.
Nicol, Mark P.
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Mitrani, L., Dickson-Hall, L., Le Roux, S., Grant, A. D., Kielmann, K., Mlisana, K., Moshabela, M., Nicol, M. P., Black, J. & Cox, H. (2021) Diverse clinical and social circumstances: Developing patient-centred care for DR-TB patients in South Africa. Public Health Action (In Press).
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 13 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 Median age was 35; 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%). 44/194 (23%) patients were reported to be employed. Other socio-economic challenges included substance abuse (17/194, 9%) and ill family members (17/194, 9%). 13% and 42% of patients were estimated to travel more than 20 km to reach their diagnosing and treatment-initiating healthcare facility, respectively.Conclusions. DR-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.