Determinants and Outcomes of the Decentralised Management of Patients With Drug-resistant Tuberculosis in the O.r Tambo District Municipality, Eastern Cape, South Africa, a Cohort Study

Abstract

Abstract Background Drug resistant tuberculosis (DR-TB) continues to plague the global community, particularly sub-Saharan Africa, with South Africa bearing a high burden of the disease. Several strategies have been developed and recommended for implementation to improve the outlook of DR-TB management. In 2018, the O.R. Tambo District Municipality implemented a decentralised community-based DR-TB care model. This study aimed to evaluate the effectiveness of the model, with the specific objective of identifying the determinants of successful community-based DR-TB management in the district. Methods A prospective longitudinal cohort study was conducted, enrolling all patients diagnosed with DR-TB in the O.R. Tambo District Municipality, with most managed at five decentralised sites in the district and some managed at the centralised Nkqubela Chest Hospital in the Buffalo City Metropolitan Municipality. Results A total of 454 patients from six facilities (five decentralised and one centralised) from 2018 to 2020 participated in the study. Their average age was 37.54 years (SD=14.94). There was a preponderance of males in the cohort, at 56.2%, and 62.9% were HIV positive. The combined treatment success was 62.4%, with 34.3% of patients being cured of DR-TB and 28.1% completing their treatment. In total, 11.1% of the cohort died during the study period, and 9.6% were reported as loss to follow-up (LTFU). There were no statistically significant differences between outcomes among patients seen at the decentralised district level and those managed at the centralised specialist hospital. Conclusion The decentralised community DR-TB care model was effective, as revealed in the treatment success rate of 62.4% and low reported deaths and patient LTFU. In addition, the decentralised care model was not inferior in any respect to the centralised management of DR-TB. Contribution: This study furthered our understanding of the impact and effectiveness (improved treatment success and low loss to follow up) of the decentralised community management of DR-TB in the OR Tambo district.