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Linkage to treatment following RR-TB diagnosis in the Western Cape
Includes bibliographical references
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| Main Author: | |
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
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Health Economics Unit
2016
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| _version_ | 1867613344579452928 |
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| access_status_str | Open Access |
| author | Tomlinson, Catherine Reid |
| author2 | Govender, Veloshnee |
| author_browse | Govender, Veloshnee Tomlinson, Catherine Reid |
| author_facet | Govender, Veloshnee Tomlinson, Catherine Reid |
| author_sort | Tomlinson, Catherine Reid |
| collection | Thesis |
| description | Includes bibliographical references |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/16776 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:34:39.702Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2016 |
| publishDateRange | 2016 |
| publishDateSort | 2016 |
| publisher | Health Economics Unit |
| publisherStr | Health Economics Unit |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/16776 Linkage to treatment following RR-TB diagnosis in the Western Cape Tomlinson, Catherine Reid Govender, Veloshnee Orgill, Marsha Health Economics Includes bibliographical references Patients diagnosed with rifampicin resistant (RR) tuberculosis (TB) in South Africa frequently fail to link to appropriate drug resistant (DR) TB treatment. The aim of this study was to explore barriers and enablers to expedited linkage to treatment following RR-TB diagnosis in the Western Cape Province, within the context of ongoing decentralisation of DRTB services and the scale-up of Xpert MTB/RIF diagnostics. Methods: An embedded case study approach, using qualitative research methods, was employed to explore barriers and enablers to expedited treatment linkage following RR-TB diagnosis. The case of investigation in this study was 'treatment linkage following RR-TB diagnosis in the Western Cape Province during the ongoing decentralisation of DR-TB services and scale-up of Xpert diagnostics'. DR-TB is used in this study as an encompassing term to refer to RR, multidrug resistant and extensively drug resistant TB. The embedded units of analysis in this study were patients' linkage outputs, defined as: (1) expedited treatment initiation, (2) delayed treatment initiation and (3) non-initiation of treatment following sputum collection on which RR-TB was diagnosed. Seventeen patient, 8 family member, 49 healthcare worker and 4 key informant open-ended, in-depth interviews were conducted and 59 patient folders were reviewed. Additionally, an extensive literature review was conducted. The tools used for data collection in this study were developed from the literature review and Coker et al.'s (201) conceptual framework for evaluation of a communicable disease intervention. A framework approach using Coker et al.'s conceptual framework was applied for analysis. Results: This study identified multiple factors that enabled and constrained expedited treatment linkage following RR-TB diagnosis. Enabling factors included: 1) the availability of clinic level DR-TB counsellors and tracers; 2) living in walking distance of decentralised services and 3) having a strong social support network. Constraining factors included: 1) low usage of Xpert diagnostics, 2) delays in acting on results and missed (or unseen) results, 3) rotation of nurses or the lack of dedicated TB nurses in clinics, 4) limited clinic-level administrative support, 5) information systems challenges and 6) waiting lists for beds and limited access to transport services in rural areas . In linking to treatment, patients commonly face challenges due to competing subsistence needs and household or employment responsibilities. Additionally, substance addiction, having a history of treatment interruption, hopelessness regarding treatment, as well as not having a stable place to stay or social support may increase patients' risks of linkage failure. Conclusion: Within the Western Cape Province, there is significant opportunity to improve linkage to treatment through strengthening the health systems mechanisms to link patients to treatment following RR-TB diagnosis. Expanding access to psychosocial services (substance abuse rehabilitation and psychosocial evaluations) following RR-TB diagnosis may assist in linking high-risk patients to treatment. Additionally, the provision of food support (in addition to social grants) should be evaluated as a tactic to improve treatment linkage and adherence. 2016-02-05T07:18:31Z 2016-02-05T07:18:31Z 2015 Master Thesis Masters MPH http://hdl.handle.net/11427/16776 eng application/pdf Health Economics Unit Faculty of Health Sciences University of Cape Town |
| spellingShingle | Health Economics Tomlinson, Catherine Reid Linkage to treatment following RR-TB diagnosis in the Western Cape |
| thesis_degree_str | Master's |
| title | Linkage to treatment following RR-TB diagnosis in the Western Cape |
| title_full | Linkage to treatment following RR-TB diagnosis in the Western Cape |
| title_fullStr | Linkage to treatment following RR-TB diagnosis in the Western Cape |
| title_full_unstemmed | Linkage to treatment following RR-TB diagnosis in the Western Cape |
| title_short | Linkage to treatment following RR-TB diagnosis in the Western Cape |
| title_sort | linkage to treatment following rr tb diagnosis in the western cape |
| topic | Health Economics |
| url | http://hdl.handle.net/11427/16776 |
| work_keys_str_mv | AT tomlinsoncatherinereid linkagetotreatmentfollowingrrtbdiagnosisinthewesterncape |