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Int J Tuberc Lung Dis. 2015 Feb;19(2):163-71. doi: 10.5588/ijtld.14.0369.

Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.

Author information

1
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
2
TB and HIV Investigative Network (Think), Durban, South Africa.
3
Department of Medicine, Montefiore Medical Center & Albert Einstein College of Medicine, New York, New York, USA.
4
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
5
Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
6
KwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
7
King Dinuzulu Hospital, Durban, South Africa.
8
Harvard University School of Medicine, Boston, Massachusetts, USA.
9
Centre for the AIDS Programme of Research in South Africa, Durban, South Africa.

Abstract

SETTING:

KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection.

OBJECTIVE:

To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital.

DESIGN:

A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation.

RESULTS:

Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites.

CONCLUSION:

Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.

PMID:
25574914
PMCID:
PMC4324454
DOI:
10.5588/ijtld.14.0369
[Indexed for MEDLINE]
Free PMC Article

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