Drug-resistant tuberculosis patient care journeys in South Africa: a pilot study using routine laboratory data

J Hill, L Dickson-Hall, A D Grant, C Grundy, J Black, K Kielmann, K Mlisana, L Mitrani, M Loveday, M Moshabela, S Le Roux, W Jassat, M Nicol, H Cox

Research output: Contribution to journalArticle

Abstract

SETTING: Thirteen districts in Eastern Cape (EC), KwaZulu-Natal (KZN) and Western Cape (WC) Provinces, South Africa.OBJECTIVE: To pilot a methodology for describing and visualising healthcare journeys among drug-resistant tuberculosis (DR-TB) patients using routine laboratory records.DESIGN: Laboratory records were obtained for 195 patients with laboratory-detected rifampicin-resistant TB (RR-TB) during July-September 2016. Health facility visits identified from these data were plotted to visualise patient healthcare journeys. Data were verified by facility visits.RESULTS: In the 9 months after the index RR-TB sample was collected, patients visited a mean of 2.3 health facilities (95% CI 2.1-2.6), with 9% visiting ≥4 facilities. The median distance travelled by patients from rural areas (116 km, interquartile range [IQR] 50-290) was greater than for urban patients (51 km, IQR 9-140). A median of 21% of patient's time was spent under the care of primary healthcare facilities: this was respectively 6%, 37% and 39% in KZN, EC and WC. Journey patterns were generally similar within districts. Some reflected a semi-centralised model of care where patients were referred to regional hospitals; other journeys showed greater involvement of primary care.CONCLUSION: Routine laboratory data can be used to explore DR-TB patient healthcare journeys and show how the use of healthcare services for DR-TB varies in different settings.

Original languageEnglish
Pages (from-to)83-91
Number of pages9
JournalInternational Journal of Tuberculosis & Lung Disease
Volume24
Issue number1
DOIs
Publication statusPublished - 1 Jan 2020
Externally publishedYes

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