CC BY 4.0 DEED Attribution 4.0 InternationalDickson, LindyLe Roux, Sacha RoxanneMitrani, LeilaHill, JeremyJassat, WaasilaCox, HelenMlisana, KolekaBlack, JohnLoveday, MarianGrant, AlisonKielmann, KarinaNdjeka, NorbertMoshabela, MosaNicol, Mark2023-11-272023-11-272023-11-182023-03-03Dickson, L., Le Roux, S.R., Mitrani, L., Hill, J., Jassat, W., Cox, H., Mlisana, K., Black, J., Loveday, M., Grant, A., Kielmann, K., Ndjeka, N., Moshabela, M. and Nicol, M. (2023) ‘Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study’, BMJ Open, 13(11), p. e067121. Available at: https://doi.org/10.1136/bmjopen-2022-067121.https://eresearch.qmu.ac.uk/handle/20.500.12289/13548https://doi.org/10.1136/bmjopen-2022-067121From BMJ via Jisc Publications RouterHistory: received 2023-03-03, accepted 2023-10-09, ppub 2023-11, epub 2023-11-18Peer reviewed: TrueAcknowledgements: The authors wish to thank the Departments of Health of the Western Cape, Eastern Cape, KwaZulu-Natal, and acknowledge the staff at the NHLS for their tremendous input and assistance. We give special mention to the late Dr Iqbal Masters and Mrs Anna Maria Evans for their contributions to the study. We also appreciate the support of Staff Nurse Cheryl Liedeman and Dr Widaad Zemanay.Publication status: PublishedFunder: Medical Research Council; FundRef: http://dx.doi.org/10.13039/501100000265; Grant(s): MR/N015924/1Funder: Wellcome Trust; FundRef: http://dx.doi.org/10.13039/100010269; Grant(s): MR/N015924/1Funder: Australian National Health and Medical Research Council; Grant(s): APP1174455Karina Kielmann - ORCID: 0000-0001-5519-1658 https://orcid.org/0000-0001-5519-1658Objectives: Treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is increasingly transitioning from hospital-centred to community-based care. A national policy for decentralised programmatic MDR/RR-TB care was adopted in South Africa in 2011. We explored variations in the implementation of care models in response to this change in policy, and the implications of these variations for people affected by MDR/RR-TB. Design: A mixed methods study was done of patient movements between healthcare facilities, reconstructed from laboratory records. Facility visits and staff interviews were used to determine reasons for movements. Participants and setting: People identified with MDR/RR-TB from 13 high-burden districts within South Africa. Outcome measures: Geospatial movement patterns were used to identify organisational models. Reasons for patient movement and implications of different organisational models for people affected by MDR/RR-TB and the health system were determined. Results: Among 191 participants, six dominant geospatial movement patterns were identified, which varied in average hospital stay (0–281 days), average patient distance travelled (12–198 km) and number of health facilities involved in care (1–5 facilities). More centralised models were associated with longer delays to treatment initiation and lengthy hospitalisation. Decentralised models facilitated family-centred care and were associated with reduced time to treatment and hospitalisation duration. Responsiveness to the needs of people affected by MDR/RR-TB and health system constraints was achieved through implementation of flexible models, or the implementation of multiple models in a district. Conclusions: Understanding how models for organising care have evolved may assist policy implementers to tailor implementation to promote particular patterns of care organisation or encourage flexibility, based on patient needs and local health system resources. Our approach can contribute towards the development of a health systems typology for understanding how policy-driven models of service delivery are implemented in the context of variable resources.Licence for this article starting on 2023-11-18: https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.http://creativecommons.org/licenses/by/4.0/Patient-Centered CareTuberculosisOrganisation of health servicesQUALITATIVE RESEARCHHealth policyPUBLIC HEALTHarticle2023-11-23