Community-based care vs. centralised hospitalisation for MDRTB patients, KwaZulu-Natal, South Africa

M. Loveday, K. Wallengren, J. Brust, J. Roberts, A. Voce, B. Margot, J. Ngozo, I. Master, G. Cassell, N. Padayatchi

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

SETTING: KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE: To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital. DESIGN: A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation. RESULTS: Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P=0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites. CONCLUSION: Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.

Original languageEnglish (US)
Pages (from-to)163-171
Number of pages9
JournalInternational Journal of Tuberculosis and Lung Disease
Volume19
Issue number2
DOIs
StatePublished - Feb 1 2015

Keywords

  • HIV
  • Models of care
  • Outcomes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

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    Loveday, M., Wallengren, K., Brust, J., Roberts, J., Voce, A., Margot, B., Ngozo, J., Master, I., Cassell, G., & Padayatchi, N. (2015). Community-based care vs. centralised hospitalisation for MDRTB patients, KwaZulu-Natal, South Africa. International Journal of Tuberculosis and Lung Disease, 19(2), 163-171. https://doi.org/10.5588/ijtld.14.0369