Community-based treatment of drug-resistant tuberculosis in Khayelitsha, South Africa

Abstract

Community-based DR-TB management is feasible, and contributes to improved case detection, reduced treatment delay and improved survival. Treatment outcomes remain poor, highlighting the poor efficacy, tolerability and lengthy duration of current treatment.

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis

“…481 Programmes in Lesotho, India, and Peru led by non-governmental organisations have challenged health services to recognise different ways, appropriate to the local context, to manage drug-resistant tuberculosis other than in hospitals. 482 …”

Outcomes in Adolescents Undergoing Treatment for Drug-resistant Tuberculosis in Cape Town, South Africa, 2008-2013

“…It has a high burden of HIV and TB with a 69 % HIV/DR-TB confection rate in 2011 (22). Antenatal HIV prevalence was 33% in 2010 (24).…”

“…The outcomes for the entire cohort have been reported elsewhere in the literature (22). The adolescent outcomes are presented separately here given the poor treatment outcomes seen in the Mumbai cohort (15) and since this is to our knowledge one of the largest cohorts of adolescent patients reported in the literature.…”

“…The details of the entire DR-TB cohort in Khayelitsha and a description of the methodology have been described in detail elsewhere (22,27). In summary, the following elements were added to the existing TB programme at primary care level: -DR-TB specific staff training and clinical support, DR-TB counseling, social assistance, programme supervision and evaluation, TB infection control support and advice, a local sub-acute short stay facility and specialist outreach services for pediatrics and audiometry screening (22).…”

“…The details of the entire DR-TB cohort in Khayelitsha and a description of the methodology have been described in detail elsewhere (22,27). In summary, the following elements were added to the existing TB programme at primary care level: -DR-TB specific staff training and clinical support, DR-TB counseling, social assistance, programme supervision and evaluation, TB infection control support and advice, a local sub-acute short stay facility and specialist outreach services for pediatrics and audiometry screening (22). In addition to primary care services that include HIV testing and counselling, DR-TB services provided at the primary care clinics include nurse and medical officer consultation, sputum collection for diagnosis and treatment monitoring, DR-TB specific counselling, directly observed therapy (DOT) and administration of injectable drugs where they have been prescribed.…”