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PLoS One. 2014 Apr 9;9(4):e94016. doi: 10.1371/journal.pone.0094016. eCollection 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.

Author information

1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
2
Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
3
Tuberculosis & HIV Investigative Network of KwaZulu-Natal (THINK), Durban, South Africa.
4
Retired from Centres for Disease Control and Prevention, Atlanta, Georgia, United States of America.
5
Department of Medicine, Montefiore Medical Center & Albert Einstein College of Medicine, Bronx, New York, United States of America.
6
KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
7
King Dinuzulu Hospital Complex, KwaZulu-Natal Department of Health, Durban, South Africa.
8
Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.

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.

PMID:
24718306
PMCID:
PMC3981751
DOI:
10.1371/journal.pone.0094016
[Indexed for MEDLINE]
Free PMC Article
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