Researchers from the Institute of Global Health and Development (IGHD) at Queen Margaret University in Edinburgh have been awarded funding for a series of projects examining how health systems in South Africa and Latvia might improve access and quality of care for patients with tuberculosis (TB).
Known as a disease of the poor, TB remains a significant cause of disease and death globally. Failure to effectively control the TB epidemic has resulted in the rise of TB bacteria that are resistant to the main drugs used in treatment. These drug-resistant bacteria can then be transmitted to others and although treatment is available, it is lengthy, complicated, expensive, and results in poor patient outcomes.
There have been recent medical advances, including a rapid diagnostic test for drug resistant TB (DR-TB) which has been rolled out across South Africa, and a new drug Bedaquiline which has the potential to dramatically improve the effectiveness of DR-TB treatment. In order to increase access and decrease delays in starting treatment, these developments are being delivered in a decentralised manner through the country’s existing health system.
In collaboration with the University of Cape Town’s Department of Medical Microbiology, IGHD at Queen Margaret University has received £52,000 funding from the Joint Health Systems Research Initiative, funded through the Economic and Social Research Council, Department for International Development, The Wellcome Trust and the Medical Research Council, to better understand the health systems constraints and enablers for the successful implementation of decentralized care for DR-TB patients in South Africa.
IGHD project lead Dr Karina Kielmann said: “There is huge diversity in the ways and extent to which care for DR-TB is being decentralized across health districts in South
Africa - and substantial variation in the performance of the DR-TB program in relation to key measures of success such as linkage to appropriate care and treatment outcomes. Our aim in this four-year project is to undertake an in-depth analysis of the health policy and systems context and to identify factors that determine what kinds of models are working to improve patient outcomes, and why these models work, across different settings.”
The Latvian project looks at issues of access to care and adherence to TB treatment for vulnerable individuals.
“Sticking with TB treatment is key to a successful outcome for patients, and can be a real challenge for individuals who struggle with alcohol or drug dependency, and who may lack social or financial support to encourage positive health-seeking behaviour,” says Dr Kielmann who is working on this research with colleagues at IGHD and at the London School of Hygiene and Tropical Medicine.
“In collaboration with partners at the Centre for Tuberculosis and Lung Disease, based at Riga East Clinical Hospital, we have developed and piloted a social risk screening tool that will help us identify those individuals likely to struggle with adherence to treatment, as well as tailored adherence support mechanisms for those patients at risk of dropping out of treatment. In both projects, we hope to contribute to strengthening health systems to improve TB patients’ pathway to care and outcomes.”
The project in Latvia is funded through the European Centre for Disease Prevention and Control (ECDC) and managed by the World Health Communication Associates.
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