MDR-TB patients in KwaZulu-Natal, South Africa: Cost-effectiveness of 5 models of care

Abstract Background: The presence of family members and their active involvement in caring for hospitalised children is an established practice in many African paediatric settings, with family members often regarded as a resource. This aspect of African paediatric nursing practice lacks formal expression or a clear conceptual basis, and difficulties arise when applying concepts of family involvement originating from the higher-resourced and culturally distinct practice environments of the global North. The aim of this study was to articulate a nurse-led practice innovation intended to facilitate family involvement in the care of hospitalised children, observed in a paediatric inpatient ward in a district hospital in rural KwaZulu-Natal, South Africa.Methods: A qualitative case study design was used. Data collection included visual research methods (graphic facilitation, sociograms and photo-elicitation) as well as a focus group, interviews and practice observation. Activities associated with 20 nurses and 22 mother-child dyads were observed. Data were subjected to content analysis, with Standards for Reporting Qualitative Research (SRQR) applied. Results: Findings relate to six aspects of practice, categorised thematically as: preserving the mother-child pair; enabling continuous presence; psychological support and empathy; sharing knowledge; mothers as a resource; and belief and trust. Conclusion: The nursing practices and organisational policies observed in this setting relating to the facilitation of continuous maternal presence represent a distinctive nursing practice innovation. This deliberate practice contrasts with models of care provision which originate in the global North, such as Family Centred Care, and contrasts with informal practices in local African settings which tolerate the presence of mothers in other settings, as well as local institutional policies which limit mothers’ presence to varying extents.

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Adverse Events in an Integrated Home-Based Treatment Program for MDR-TB and HIV in KwaZulu-Natal, South Africa

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e31828175ed ◽

2013 ◽

Vol 62 (4) ◽

pp. 436-440 ◽

Cited By ~ 14

Author(s):

James C. M. Brust ◽

N. Sarita Shah ◽

Theo L. van der Merwe ◽

Sheila Bamber ◽

Yuming Ning ◽

...

Keyword(s):

South Africa ◽

Adverse Events ◽

Treatment Program ◽

Home Based ◽

Kwazulu Natal ◽

Mdr Tb

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Cost-effectiveness of bedaquiline, pretomanid and linezolid for treatment of extensively drug-resistant tuberculosis in South Africa, Georgia and the Philippines

BMJ Open ◽

10.1136/bmjopen-2021-051521 ◽

2021 ◽

Vol 11 (12) ◽

pp. e051521

Author(s):

Gabriela Beatriz Gomez ◽

Mariana Siapka ◽

Francesca Conradie ◽

Norbert Ndjeka ◽

Anna Marie Celina Garfin ◽

...

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

Standard Of Care ◽

The Philippines ◽

List Price ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Mdr Tb

ObjectivesPatients with highly resistant tuberculosis have few treatment options. Bedaquiline, pretomanid and linezolid regimen (BPaL) is a new regimen shown to have favourable outcomes after six months. We present an economic evaluation of introducing BPaL against the extensively drug-resistant tuberculosis (XDR-TB) standard of care in three epidemiological settings.DesignCost-effectiveness analysis using Markov cohort model.SettingSouth Africa, Georgia and the Philippines.ParticipantsXDR-TB and multidrug-resistant tuberculosis (MDR-TB) failure and treatment intolerant patients.InterventionsBPaL regimen.Primary and secondary outcome measures(1) Incremental cost per disability-adjusted life years averted by using BPaL against standard of care at the Global Drug Facility list price. (2) The potential maximum price at which the BPaL regimen could become cost neutral.ResultsBPaL for XDR-TB is likely to be cost saving in all study settings when pretomanid is priced at the Global Drug Facility list price. The magnitude of these savings depends on the prevalence of XDR-TB in the country and can amount, over 5 years, to approximately US$ 3 million in South Africa, US$ 200 000 and US$ 60 000 in Georgia and the Philippines, respectively. In South Africa, related future costs of antiretroviral treatment (ART) due to survival of more patients following treatment with BPaL reduced the magnitude of expected savings to approximately US$ 1 million. Overall, when BPaL is introduced to a wider population, including MDR-TB treatment failure and treatment intolerant, we observe increased savings and clinical benefits. The potential threshold price at which the probability of the introduction of BPaL becoming cost neutral begins to increase is higher in Georgia and the Philippines (US$ 3650 and US$ 3800, respectively) compared with South Africa (US$ 500) including ART costs.ConclusionsOur results estimate that BPaL can be a cost-saving addition to the local TB programmes in varied programmatic settings.

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High Rates of Potentially Infectious Tuberculosis and Multidrug-Resistant Tuberculosis (MDR-TB) among Hospital Inpatients in KwaZulu Natal, South Africa Indicate Risk of Nosocomial Transmission

PLoS ONE ◽

10.1371/journal.pone.0090868 ◽

2014 ◽

Vol 9 (3) ◽

pp. e90868 ◽

Cited By ~ 18

Author(s):

Nonkqubela Bantubani ◽

Gaetan Kabera ◽

Catherine Connolly ◽

Roxana Rustomjee ◽

Tarylee Reddy ◽

...

Keyword(s):

South Africa ◽

Multidrug Resistant ◽

Nosocomial Transmission ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Kwazulu Natal ◽

Mdr Tb ◽

Hospital Inpatients

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Evolving rifampicin and isoniazid mono-resistance in a high multidrug-resistant and extensively drug-resistant tuberculosis region: a retrospective data analysis

BMJ Open ◽

10.1136/bmjopen-2019-031663 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031663

Author(s):

Nomonde Ritta Mvelase ◽

Yusentha Balakrishna ◽

Keeren Lutchminarain ◽

Koleka Mlisana

Keyword(s):

South Africa ◽

Diagnostic Algorithm ◽

Multidrug Resistant ◽

Continuous Phase ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Kwazulu Natal ◽

Mdr Tb

ObjectivesSouth Africa ranks among the highest drug-resistant tuberculosis (DR-TB) burdened countries in the world. This study assessed the changes in resistance levels in culture confirmed Mycobacterium tuberculosis (MTB) in the highest burdened province of South Africa during a period where major changes in diagnostic algorithm were implemented.SettingThis study was conducted at the central academic laboratory of the KwaZulu-Natal province of South Africa.ParticipantsWe analysed data for all MTB cultures performed in the KwaZulu-Natal province between 2011 and 2014. The data were collected from the laboratory information system.ResultsOut of 88 559 drug susceptibility results analysed, 18 352 (20.7%) were resistant to rifampicin (RIF) and 19 190 (21.7%) showed resistance to isoniazid (INH). The proportion of rifampicin resistant cases that were mono-resistant increased from 15.3% in 2011 to 21.4% in 2014 while INH mono-resistance (IMR) showed a range between 13.8% and 21.1%. The multidrug-resistant tuberculosis (MDR-TB) rates increased from 18.8% to 23.9% and the proportion of MDR-TB cases that had extensively drug-resistant tuberculosis remained between 10.2% and 11.1%. Most drug resistance was found in females between the ages of 15 and 44 years and the northern districts bordering high MDR-TB regions had the highest MDR-TB rates.ConclusionOur findings show increasing RIF mono-resistance (RMR) and a substantial amount of IMR. This highlights a need for an initial test that detects resistance to both these drugs so as to avoid using RIF monotherapy during continuous phase of treatment in patients with IMR. Furthermore, addition of INH will benefit patients with RMR. Although DR-TB is widespread, HIV and migration influence its distribution; therefore, TB control strategies should include interventions that target these aspects.

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The costs and cost effectiveness of providing first-trimester, medical and surgical safe abortion services in KwaZulu-Natal Province, South Africa

PLoS ONE ◽

10.1371/journal.pone.0174615 ◽

2017 ◽

Vol 12 (4) ◽

pp. e0174615 ◽

Cited By ~ 8

Author(s):

Naomi Lince-Deroche ◽

Tamara Fetters ◽

Edina Sinanovic ◽

Jaymala Devjee ◽

Jack Moodley ◽

...

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

First Trimester ◽

Safe Abortion ◽

Kwazulu Natal

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Cost-effectiveness of staff and workload profiles in retaining patients on antiretroviral therapy in KwaZulu-Natal, South Africa

AIDS Care ◽

10.1080/09540121.2011.554517 ◽

2011 ◽

Vol 23 (9) ◽

pp. 1146-1153 ◽

Cited By ~ 5

Author(s):

Venanzio Vella ◽

Thiloshini Govender ◽

Sicelo S. Dlamini ◽

Indres Moodley ◽

Verona David ◽

...

Keyword(s):

South Africa ◽

Cost Effectiveness ◽

Antiretroviral Therapy ◽

Kwazulu Natal

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Association between Health Systems Performance and Treatment Outcomes in Patients Co-Infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: Implications for TB Programmes

PLoS ONE ◽

10.1371/journal.pone.0094016 ◽

2014 ◽

Vol 9 (4) ◽

pp. e94016 ◽

Cited By ~ 13

Author(s):

Marian Loveday ◽

Nesri Padayatchi ◽

Kristina Wallengren ◽

Jacquelin Roberts ◽

James C. M. Brust ◽

...

Keyword(s):

South Africa ◽

Treatment Outcomes ◽

Health Systems ◽

Kwazulu Natal ◽

Mdr Tb ◽

Health Systems Performance

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Love, sex, drugs and women’s sub-optimal adherence to MDR-TB treatment in South Africa: Opportunities for enhanced health education

Health Education Journal ◽

10.1177/00178969211035165 ◽

2021 ◽

pp. 001789692110351

Author(s):

Petronella Chipo Mugoni

Keyword(s):

South Africa ◽

Treatment Adherence ◽

Cultural Beliefs ◽

Infection Prevention And Control ◽

Adherence To Treatment ◽

Tb Treatment ◽

Kwazulu Natal ◽

Mdr Tb ◽

Lengthy Treatment ◽

Optimal Adherence

Objective: Rising incidence of acquired multidrug-resistant tuberculosis (MDR-TB) in South Africa suggests low knowledge and implementation of infection prevention and control strategies in household and congregate settings. This study contributes to the under-researched area of non-biomedical responses to sub-adherence to treatment. Design: The study utilises a quasi-ethnographic qualitative case study of 10 women aged 18 to 34 years to understand their treatment adherence behaviours through the lens of their sex, gender, age, cultural beliefs and socio-economic status. Setting: This study investigated reasons for young women’s sub-optimal adherence to treatment for acquired MDR-TB in eThekwini Metro, KwaZulu-Natal province, South Africa, which records high burdens of tuberculosis (TB), MDR-TB and HIV. Methods: Primary data were collected from 20 participants who were selected through criterion, purposive and snowball sampling. Data were gathered through focus group discussions with women being treated for transmitted MDR-TB and key informant interviews with their family members, health workers and KwaZulu-Natal Provincial Department of Health personnel. Results: Anti-MDR-TB treatment affects women’s sexuality, intimate relationships, family planning intentions and reproductive health. Some vulnerable women struggle to persevere on noxious and lengthy treatment regimes that affect their reproductive and psychological health. Women may skip doses or abandon treatment when high pill burdens and adverse events make intimate and sexual relations with male partners, on whom they may depend for their livelihoods, difficult. Conclusion: It is important to consider the effects of lengthy treatment on young people’s social and sexual lives and self-esteem when (re)designing MDR-TB counselling approaches. This paper advances an evidence-based treatment education and counselling strategy to contribute to improving MDR-TB treatment adherence and success.

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Distinctive nursing practices in working with mothers to care for hospitalised children at a district hospital in KwaZulu-Natal, South Africa: a descriptive observational study

10.21203/rs.2.23238/v2 ◽

2020 ◽

Author(s):

Natasha North ◽

Angela Leonard ◽

Candice Bonaconsa ◽

Thobeka Duma ◽

Minette Coetzee

Keyword(s):

South Africa ◽

Family Involvement ◽

Nursing Practice ◽

District Hospital ◽

Family Members ◽

Models Of Care ◽

Inpatient Ward ◽

Active Involvement ◽

Visual Research Methods ◽

Kwazulu Natal

Abstract Background: The presence of family members and their active involvement in caring for hospitalised children is an established practice in many African paediatric settings, with family members often regarded as a resource. This aspect of African paediatric nursing practice lacks formal expression or a clear conceptual basis, and difficulties arise when applying concepts of family involvement originating from the culturally distinct practice environments of higher resourced settings including Europe and America. The aim of this study was to articulate a nurse-led practice innovation intended to facilitate family involvement in the care of hospitalised children, observed in a paediatric inpatient ward in a district hospital in rural KwaZulu-Natal, South Africa. Methods: A qualitative case study design was used. Data collection included visual research methods (graphic facilitation, sociograms and photo-elicitation) as well as a focus group, interviews and practice observation. Activities associated with 20 nurses and 22 mother-child dyads were observed. Data were subjected to content analysis, with Standards for Reporting Qualitative Research (SRQR) applied. Results: Findings relate to six aspects of practice, categorised thematically as: preserving the mother-child pair; enabling continuous presence; psychological support and empathy; sharing knowledge; mothers as a resource; and belief and trust. Conclusion: The nursing practices and organisational policies observed in this setting relating to the facilitation of continuous maternal presence represent a distinctive nursing practice innovation. This deliberate practice contrasts with models of care provision which originate in higher resourced settings including Europe and America, such as Family Centred Care, and contrasts with informal practices in local African settings which tolerate the presence of mothers in other settings, as well as local institutional policies which limit mothers’ presence to varying extents.

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