Abstract
SETTING: Thirteen districts in Eastern Cape (EC), KwaZulu-Natal (KZN) and Western Cape (WC) Provinces, South Africa.OBJECTIVE: To pilot a methodology for describing and visualising healthcare journeys among drug-resistant tuberculosis (DR-TB) patients using routine laboratory records.DESIGN: Laboratory records were obtained for 195 patients with laboratory-detected rifampicin-resistant TB (RR-TB) during July-September 2016. Health facility visits identified from these data were plotted to visualise patient healthcare journeys. Data were verified by facility visits.RESULTS: In the 9 months after the index RR-TB sample was collected, patients visited a mean of 2.3 health facilities (95% CI 2.1-2.6), with 9% visiting ≥4 facilities. The median distance travelled by patients from rural areas (116 km, interquartile range [IQR] 50-290) was greater than for urban patients (51 km, IQR 9-140). A median of 21% of patient's time was spent under the care of primary healthcare facilities: this was respectively 6%, 37% and 39% in KZN, EC and WC. Journey patterns were generally similar within districts. Some reflected a semi-centralised model of care where patients were referred to regional hospitals; other journeys showed greater involvement of primary care.CONCLUSION: Routine laboratory data can be used to explore DR-TB patient healthcare journeys and show how the use of healthcare services for DR-TB varies in different settings.
Highlights
SOUTH AFRICA CONTRIBUTES 10% of the total global burden of notified drug-resistant tuberculosis (DR-TB, defined as resistance to at least rifampicin, and including multi- and extensively DR-TB), with 16 733 patients diagnosed in 2017.1 While a large number of patients are diagnosed nationally, only 64% were estimated to have started second-line treatment in 2013.2 Treatment outcomes are poor, with only 55% treatment success among those starting treatment in 2015.1
The pilot study was conducted in 13 districts across three of the nine South African provinces: Eastern Cape (EC), KwaZulu-Natal (KZN) and Western Cape (WC)
All facility visits identified using laboratory data for these patients were confirmed in clinical records
Summary
As part of a broader health systems research project investigating how health systems may be optimised to deliver highquality, patient-centred, decentralised care for DRTB, we aimed to pilot a methodology that utilises routine laboratory data to describe and visualise patient pathways through healthcare services
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