Determinants and Outcomes of the Decentralised Management of Patients With Drug-resistant Tuberculosis in the O.r Tambo District Municipality, Eastern Cape, South Africa, a Cohort Study

Abstract

<title>Abstract</title> <bold>Background</bold> Drug resistant tuberculosis (DR-TB) continues to plague the global community, particularly sub-Saharan Africa, with South Africa bearing a high burden of the disease. Several strategies have been developed and recommended for implementation to improve the outlook of DR-TB management. In 2018, the O.R. Tambo District Municipality implemented a decentralised community-based DR-TB care model. This study aimed to evaluate the effectiveness of the model, with the specific objective of identifying the determinants of successful community-based DR-TB management in the district. <bold>Methods</bold> A prospective longitudinal cohort study was conducted, enrolling all patients diagnosed with DR-TB in the O.R. Tambo District Municipality, with most managed at five decentralised sites in the district and some managed at the centralised Nkqubela Chest Hospital in the Buffalo City Metropolitan Municipality. <bold>Results</bold> A total of 454 patients from six facilities (five decentralised and one centralised) from 2018 to 2020 participated in the study. Their average age was 37.54 years (SD=14.94). There was a preponderance of males in the cohort, at 56.2%, and 62.9% were HIV positive. The combined treatment success was 62.4%, with 34.3% of patients being cured of DR-TB and 28.1% completing their treatment. In total, 11.1% of the cohort died during the study period, and 9.6% were reported as loss to follow-up (LTFU). There were no statistically significant differences between outcomes among patients seen at the decentralised district level and those managed at the centralised specialist hospital. <bold>Conclusion</bold> The decentralised community DR-TB care model was effective, as revealed in the treatment success rate of 62.4% and low reported deaths and patient LTFU. In addition, the decentralised care model was not inferior in any respect to the centralised management of DR-TB. <bold>Contribution: </bold>This study furthered our understanding of the impact and effectiveness (improved treatment success and low loss to follow up) of the decentralised community management of DR-TB in the OR Tambo district.