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.
| dc.contributor.author | Loveday, Marian Patricia. | |
| dc.contributor.author | Padayatchi, Nesri. | |
| dc.contributor.author | Wallengren, Kristina. | |
| dc.contributor.author | Roberts, Jacquelin. | |
| dc.contributor.author | Brust, James C. M. | |
| dc.contributor.author | Ngozo, Jacqueline. | |
| dc.contributor.author | Master, Iqbal. | |
| dc.contributor.author | Voce, Anna Silvia. | |
| dc.date.accessioned | 2016-11-08T09:57:39Z | |
| dc.date.available | 2016-11-08T09:57:39Z | |
| dc.date.created | 2014 | |
| dc.date.issued | 2014 | |
| dc.description | CAPRISA, 2014. | en_US |
| dc.description.abstract | Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. Methods: In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. Findings: We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. Conclusion: We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines. | en_US |
| dc.identifier.citation | Loveday, M., Padayatchi, N., Wallengren, K., Roberts, J., Brust, J.C., Ngozo, J., Master, I. and Voce, A. 2014. 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 9(4), e94016. | en_US |
| dc.identifier.uri | http://dx.doi.org/10.1371/journal.pone.0094016 | en_US |
| dc.identifier.uri | http://hdl.handle.net/10413/13613 | |
| dc.language.iso | en | en_US |
| dc.publisher | Public Library of Science. | en_US |
| dc.subject | Anti-HIV Agents/therapeutic use. | en_US |
| dc.subject | Attitude of Health Personnel. | en_US |
| dc.subject | Coinfection/epidemiology. | en_US |
| dc.subject | Disease Management. | en_US |
| dc.title | 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. | en_US |
| dc.type | Peer reviewed journal article | en_US |