Optimizing health systems to improve delivery of decentralised care for patients with drug resistant tuberculosis

Optimizing health systems to improve delivery of decentralised care for patients with drug resistant tuberculosis

(01 February 2016 - present)

Country: South Africa

Tuberculosis (TB) still remains a significant cause of disease and death globally. Unable to control this TB epidemic, many of the TB bacteria have become resistant to the main drugs used in treatment. This has led to strains of Drug-Resistant TB (DR-TB), i.e. TB that is resistant to at least one anti tuberculosis drug. DR-TB is much more difficult and more expensive to treat than normal TB.

With approximately 20,000 cases of DR-TB, South Africa contributes 15% of the world’s cases of DR-TB. In 2011, the National Department of Health set about decentralising DR-TB services i.e. transferring responsibility for treating DR-TB patients to a lower level of the health system so as to diagnose and initiate treatment more quickly, and provide treatment closer to patients’ homes. However, the decentralisation process has been initiated varyingly across the country with multiple models of care based on different interpretations of policy and contexts.

This project aims to understand the policy context, evolution and working models of decentralisation of DR-TB care in South Africa.

QMU's role in this project

Together with Professor Mark Nicol (University of Cape Town) and Dr Mosa Moshabela (University of Kwa Zulu Natal), Dr Karina Kielmann (IGHD) is a Co-Principal Investigator on the project. Karina advises on and guides the health systems research components. She will lead on the design and methodology for the realist evaluation study that will be undertaken to examine emerging models of decentralised DR-TB care in more depth, asking: what factors explain why some districts are better equipped to deliver patient-centred and effective care at lower levels of the health system?

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