Loveday, Marian Patricia.Padayatchi, Nesri.Wallengren, Kristina.Roberts, Jacquelin.Brust, James C. M.Ngozo, Jacqueline.Master, Iqbal.Voce, Anna Silvia.2016-11-082016-11-0820142014Loveday, 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.http://dx.doi.org/10.1371/journal.pone.0094016http://hdl.handle.net/10413/13613CAPRISA, 2014.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.enAnti-HIV Agents/therapeutic use.Attitude of Health Personnel.Coinfection/epidemiology.Disease Management.Peer reviewed journal article