Directly-Observed Treatment Strategy implementation practices in a hospital in eThekwini health district

Abstract

Background: The incidence rate of tuberculosis (TB) in South Africa remains high, with the country ranked as having the 14th-highest incidence rate internationally; 646 per 100 000 people are infected with TB nationally, whilst KwaZulu-Natal has a provincial incidence of 1466 per 100 000. The Directly-Observed Treatment Strategy (DOTS) programme is intended to ensure both treatment completion and cure of TB, as well as its evaluation. Despite improved DOTS coverage – the focus of most DOTS studies – the incidence of drug-resistant TB suggests that issues of non-compliance are centrally responsible for ongoing concerns about the implementation and practices related to DOTS.Objectives: The aim of the study was to explore and describe DOTS implementation practices. The objectives of the study were to explore and describe the DOTS implementation practices of professional nurses and to describe modifiable barriers to DOTS.Method: A qualitative, descriptive, explorative study was conducted through individual interviews until saturation was reached.Results: The study revealed that DOTS implementation was not in accordance with World Health Organization prescripts. Participants reported barriers such as limited human and material resources, ineffective communication of policy and procedural guidelines, ineffective communication between service delivery institutions and lack of continuity of care, as well as a lack of recording and reporting.Conclusion: The study recommended a comprehensive recruitment process to facilitate greater training and employment of more permanent health professionals to combat TB in the community; and to re-launch the DOTS programme in underperforming facilities. This would give much needed momentum to efforts targeted at preventing treatment defaults amongst patients. Agtergrond: Die voorkomskoers van tuberkulose (TB) in Suid-Afrika bly steeds hoog, waar die land internasionaal beskou word as met die 14de hoogste voorkomskoers; 646 per 100 000 mense is nasionaal met TB besmet, terwyl KwaZulu-Natal ’n provinsiale voorkoms van 1466 per 100 000toon. Die punte program (DOTS) is bedoel om beide die voltooiing van behandeling en genesing van TB en die evaluering daarvan te verseker. Ten spyte van verbeterde DOTS-dekking, wat die fokus van die meeste DOTS studies is, dui die voorkoms van dwelm-weerstandige TB daarop dat die kwessie van nie-nakoming sentraal verantwoordelik is vir voortgesette kommer oor die implementering en praktyke wat verband hou met DOTS. Doelwitte: Die doel van die studie was om die implementering van DOTS–praktyke te ondersoek en te beskryf. Die doelwitte van die studie was om die DOTS- implementeringspraktyke van professionele verpleegkundiges te ondersoek en te beskryf asook om veranderbare hindernisse ten opsigte van DOTS te beskryf.Metode: ’n Kwalitatiewe, beskrywende, ondersoekende studie is uitgevoer deur middel van individuele onderhoude tot die versadigspunt bereik was.Resultate: Die studie het getoon dat DOTS-implementering nie in ooreenstemming is met die WHO voorskrifte nie. Deelnemers berig struikelblokke soos beperkte menslike en materiële hulpbronne, oneffektiewe kommunikasie van beleid- en prosedureriglyne, oneffektiewe kommunikasie tussen dienslewerings-instellings en die gebrek aan kontinuïteit van sorg, sowel as ‚n gebrek aan optekening en verslaggewing.Gevolgtrekking: Die studie beveel ’n omvattende werwingsproses aan wat groter opleiding en indiensneming van meer permanente gesondheidswerkers om TB te bekamp in die gemeenskap sal fasiliteer, asook om die DOTS-program in gemeenskappe met onderpresterende geriewe herbekend te stel. Dit sal broodnodige momentum gee aan pogings wat gerig is op die voorkoming van onderbreekte behandeling onder pasiënte.