Drug-resistant tuberculosis patient care journeys in South Africa: A pilot study using routine laboratory data
Hill, Jeremy Stewart
Grant, Alison D.
Le Roux, Sacha
Cox, Helen Suzanne
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Hill, J. S., Dickson-Hall, L., Grant, A. D., Grundy, C., Black, J., Kielmann, K., Mlisana, K., Mitrani, L., Loveday, M., Moshabela, M., Le Roux, S., Jassat, W., Nicol, M. & Cox, H. S. (2019) Drug-resistant tuberculosis patient care journeys in South Africa: A pilot study using routine laboratory data. The International Journal of Tuberculosis and Lung Disease, 24(1), pp. 83-91.
SETTING: Thirteen districts in Eastern Cape (EC), KwaZulu-Natal (KZN) and Western Cape (WC) Provinces, South Africa.OBJECTIVE: To pilot a methodology for describing and visualising healthcare journeys among drug-resistant tuberculosis (DR-TB) patients using routine laboratory recordsDESIGN: Laboratory records were obtained for 195 patients with laboratory-detected rifampicin-resistant TB (RR-TB) during July–September 2016. Health facility visits identified from these data were plotted to visualise patient healthcare journeys. Data were verified by facility visits.RESULTS: In the 9 months after the index RR-TB sample was collected, patients visited a mean of 2.3 health facilities (95% CI 2.1–2.6), with 9% visiting 4 facilities. The median distance travelled by patients from rural areas (116 km, interquartile range [IQR] 50–290) was greater than for urban patients (51 km, IQR 9–140). A median of 21% of patient’s time was spent under the care of primary healthcare facilities: this was respectively 6%, 37% and 39% in KZN, EC and WC. Journey patterns were generally similar within districts. Some reflected a semi-centralised model of care where patients were referred to regional hospitals; other journeys showed greater involvement of primary care.CONCLUSION: Routine laboratory data can be used to explore DR-TB patient healthcare journeys and show how the use of healthcare services for DR-TB varies in different settings.