M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Background: In Gauteng Province, South Africa, Sizwe Tropical Hospital (STH) is the designated centre for the specialized management of MDR-TB. But during the period covered by this study (2001-2002), all cases of TB (MDR-TB and NMDR-TB) were treated at STH. This was not according to the prescript of the National guidelines. This study describes the socio-demographic, treatment profile and treatment outcomes of MDR-TB patients seen and treated at STH during 2001 and 2002. Method: This was a cross sectional study involving retrospective review of records at STH. 281 systematically-sampled MDR-TB patient records were included in this study. Descriptive statistics were used to summarize the socio-demographic and treatment history characteristics and these were further analyzed to evaluate their relationship with MDR-TB treatment outcomes using Chi squared test of association. Means were compared using simple t-test. Results: The patients were majority black, unemployed, and living in townships and informal settlements. Sputum tests alone or combined with x-ray were most commonly used to diagnose MDR-TB (98%) at referring facilities; and the majority of patients arrived at STH with a referral note (98%). The median duration of stay at STH was 56 weeks (IQR 21-89). The majority of patients had a successful treatment outcome (75%); and amongst those with unsuccessful outcomes, a significant number had died (17%). Factors associated with poor iv outcomes in terms of death, default, treatment failure and transfer out were age groups (1-9 and 30-39), race, employment status, place of residence, housing structure, referral systems (referral note and feedback procedures) and HIV status. Discussion: The patients in this study had socio-demographic characteristics that facilitate TB transmission. There is a commendable referral system but various methods used to confirm MDR-TB and unjustified long duration of treatment prior to referral. Although in general the majority of patients have successful treatment outcomes, the policy guidelines of the management of MDR-TB are not implemented fully, and several factors associated to poor outcome are related to the health service and referral system. Recommendation: Effective adherence to the policy guidelines by health care providers and patients is recommended to improve treatment outcomes.

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The study aimed to explore and describe the experiences of people treated for multidrug resistant tuberculosis (MDR-TB) in Omaheke region, Namibia in order to make relevant recommendations regarding their management. A descriptive qualitative design approach was used. Data was collected using in-depth individual interviews with six participants. The interview transcripts were analysed using thematic content analysis. Three themes emerged namely (1) Stressors related to MDR-TB diagnosis and treatment which involved nature of disease and compulsory hospitalisation (2) Impact of being treated for MDR-TB which related to emotional , social , spiritual and financial impact (3) Support structures for people treated for MDR-TB which included family members, health care professionals and friends. Systemic practical patient-centred, staff-centred and community-centred recommendations are suggested as well as recommendations for future research and an appraisal of the limitations of this study. / Health Studies / M.A. (Public Health)

Over the last few years the World Health Organization (WHO) has endorsed several tests for the rapid detection of multidrug-resistant tuberculosis (MDR-TB) in resource-poor settings. The objective of this study was to compare the cost-effectiveness of a line probe assay test (less than one week for results) to conventional (bacterial culture) drug susceptibility testing (one month for results) for the detection of MDR-TB in an HIV-positive South African population by estimating the incremental cost-effectiveness ratio (ICER) per disability-adjusted life-year (DALY) averted. Costs of testing, drug treatment, hospitalization, as well as estimates for mortality, treatment success, and failure rates were obtained from literature sources, the South African Department of Health, the WHO, the Foundation of Innovative Diagnostics (FIND), and expert opinion. The willingness-to-pay threshold for a DALY averted was pre-set at 3 times the 2009 GDP per capita (about $17,400) for South Africa. In the base-case scenario for a prevalence of 30% of MDR-TB among HIV-positive patients, the average cost per person for the line probe assay testing strategy was $3,539/0.458 DALY averted and the conventional testing approach was $3,011/0.430 DALY averted. The base-line ICER was about $18,800 per DALY averted – about $1,400 above the pre-set threshold. In sensitivity analyses, the model was robust to changes in prevalence (+ 50%); costs (+ 10%), and probabilities of death, success and failure (+ 20%). However, when the treatment success rate for the line probe assay test was increased to 60% (one of the targets set by WHO in TB treatment) the ICER was below the willingness-to-pay level (i.e., cost-effective). The probabilistic sensitivity analysis showed there is a 70% chance that the additional cost of the line probe assay, compared with conventional testing, was less than $30,000 per DALY averted. However, the model may have underestimated the benefits of the line probe assay because it did not account for a decrease in the transmission of the disease due to earlier treatment nor did it measure any benefits more than a year after testing. / text

The study aimed to explore and describe the experiences of people treated for multidrug resistant tuberculosis (MDR-TB) in Omaheke region, Namibia in order to make relevant recommendations regarding their management. A descriptive qualitative design approach was used. Data was collected using in-depth individual interviews with six participants. The interview transcripts were analysed using thematic content analysis. Three themes emerged namely (1) Stressors related to MDR-TB diagnosis and treatment which involved nature of disease and compulsory hospitalisation (2) Impact of being treated for MDR-TB which related to emotional , social , spiritual and financial impact (3) Support structures for people treated for MDR-TB which included family members, health care professionals and friends. Systemic practical patient-centred, staff-centred and community-centred recommendations are suggested as well as recommendations for future research and an appraisal of the limitations of this study. / Health Studies / M.A. (Public Health)

Master of Public Health - MPH / Decentralisation of multi-drug resistant tuberculosis (MDR-TB) services has resulted in improved access to care, with community-based treatment of MDR-TB shown to be more effective than centralised hospital-based care. Furthermore, increasing bed shortages resulted in the National Department of Health establishing MDR-TB policy guidelines in 2011. However, the extent to which this policy has been implemented by the decentralised MDR- TB sites and the factors influencing implementation of the policy from a management perspective were not well described. The aim of this study was therefore to explore and compare the actual and ascribed roles and responsibilities of key management-level role players at the decentralised MDR-TB sites, and to explore the factors influencing implementation of the MDR-TB decentralisation policy (2011).

Multidrug-resistant Mycobacterium tuberculosis (MDR-TB) is a leading cause of morbidity and mortality in the Philippines. The purpose of this study was to gain knowledge about the relationship between potential risk factors and MDR-TB. Risk factors (the independent variables) for MDR-TB (the dependent variable) include previous TB treatment, infection with HIV, exposure to patients with drug-susceptible TB/MDR-TB, delays in diagnosis and treatment, employment status, smoking, imprisonment, alcohol abuse, and poor compliance with TB treatment regimens. The study was based on the epidemiological approach to causal inference work. A case-control study design was used wherein a quantitative method was applied in data analysis to assess the strength of the pre-identified possible risk factor(s) association to MDR-TB infection. Data were collected using survey questionnaires that were administered to patients (N = 172) from health centers in Leyte, San Mateo Rizal, and San Lazaro. Hypotheses were tested using chi-square analysis, Fisher's exact test, and an odd ratio. Drug-susceptible TB respondents who smoked on a daily basis were three times more likely (95% CI 1.021-13.341, OR 3.69) to develop an MDR-TB infection than were other respondents. Respondents who did not comply with the anti-TB treatment regimen were nine times more likely (95% CI 2.104-43.059, OR 9.519) to develop an MDR-TB infection than other respondents. Health care providers may be able to use study findings to develop programs to help drug-susceptible TB patients stop smoking and better comply with treatment regimens designed to prevent MDR-TB infection, resulting, potentially, in improved public health outcomes for patients.

Philosophiae Doctor - PhD / Polyamic acid (PAA) nanostructured materials were successfully produced by electrochemical deposition and electrospinning using polyvinlypyrrolidone (PVP) as supporting polymer. Polyamic acid thin film and nanofibers were deposited directly at the surface of a screen-printed carbon electrode (SPCE) as electro-catalysts for reliable analytical reporting of sulphonamide as contaminants of emerging concern by electrochemical techniques. Fourier transform infrared (FTIR) spectroscopy was used to confirm the structural integrity of the PAA electrospun nanofibers compared to the chemical synthesized PAA. Brunauer-Emmett-Teller (BET) was used to determine the surface area of the nanofibers. The surface morphology and surface thickness of the polyamic acid (PAA) nanofibers on the screen-printed electrodes was studied using scanning electron microscopy (SEM) and atomic force microscopy (AFM). Cyclic voltammetry (CV) was used to study redox behavior of the nanostructured PAA modified screen-printed carbon electrodes. Electrochemical parameters surface concentration, diffusion coefficient, formal potential and peak separation were determined. Three sulphonamides were selected based on the United States of protection agency (US EPA) and World Health Organization (WHO) list of emerging contaminants and detected sulphonamides in environmental waters in South Africa and other African regions. The selected sulfonamides were evaluated at the unmodified and modified screen-printed carbon electrodes. The sulphonamides were evaluated in three different supporting electrolytes at pH < 7 and >7 to enhance electrochemical signal reporting. Sulfadiazine (SDZ), sulfamethoxazole (SMX) and sulfamethazine (SMZ) displayed peaks at 0.80 V vs Ag/AgCl in 0.1 M tris-HCl using square wave voltammetry at the unmodified transducer. At the PAA thin film transducer, SDZ, SMX and SMZ displayed well-defined analytical oxidative peaks at 0.77 V 0.82 V and 0.83 V vs Ag/AgCl respectively. The LOD (n=3) for SDZ was found to be 12.14 ųM with a correlation coefficient of 0.9950. The LOD (n=3) for SMX and SMZ was found to 14.59 ųM (R2 =0.9928) and 10.41 ųM (R2 =0.9963). These sulphonamides were also electro-analytical evaluated at the screen-printed carbon PAA nanofiber modified transducer. SDZ, SMX and SMZ produced well-defined analytical signals at 0.79 V, 0.81 V and 0.78 V vs Ag/AgCl respectively. The determined LOD (n=3) for the individual sulphonamides was 8.26 ųM, 16.59 ųM and 8.81 ųM SDZ, SMX and SMZ respectively. The linearity correlation coefficient (R2) was determined to be 0.9977, 0.9956 and 0.9974 respectively. The efficacy of the proposed nanostructured PAA thin film modified screen-printed carbon sensor was evaluated by performing recovery studies for the selected sulphonamides using square wave voltammetry. Tap water was used to simulate environmental matrix. The recoveries of SDZ with respect to each concentration were 98.84% (RSD 4.98%) to 40.58% (RSD 6.74%). For SMX the recoveries were 154.17% (RSD 11.00%) to 111.03% (RSD 16.80%). The recoveries for SMZ with respect to each concentration were 184% (RSD 8.19%) to 90.26 (RSD 18.26%) indicating the reliability of the analytical results. / 2021-09-01

Lic.-avh. Stockholm : Karolinska institutet, 2006.

Magister Scientiae (Occupational Therapy) - MSc(OT) / TB is a multi- faceted public health problem spurred on by the biological progression of the disease as well as the social issues associated with it. The treatment of TB is however primarily driven by the medical model where the focus is on the disease and not on a holistic view of the patient. Occupational therapy is a profession concerned with the use of occupation in the promotion of health and well being through the facilitation of the process of occupational adaptation. There is however a paucity of literature pertaining to the role that occupational therapy could play within the TB context. The aim of this study was to explore how adults with MDR- TB who undergo long-term hospitalisation at a hospital in the Western Cape experience occupational adaptation. The objectives of the study were to explore how the participants perceive their occupational identity, to explore the meaning and purpose the participants assign to their occupational engagement and to explore the how the participants perceive their occupational competence. The interpretive research paradigm employing a phenomenological qualitative research approach was utilized in this study. Purposive sampling was used to select four participants based on specific selection criteria. The data gathering methods utilized included diaries, semistructured interviews, participant observation and a focus group. Photographs taken by the researcher for the purpose of participant observation were used to elicit a rich, in depth response from the participants during the focus group discussion. All data was analysed through thematic content analysis. The study findings highlighted that the participants viewed themselves as occupational beings and that they valued the role that occupational engagement played in facilitating their occupational competence and ultimately their ability to adapt to long- term hospitalisation. The environmental demands and constraints that they experienced however infringed their engagement in meaningful occupation and hampered their ability to achieve occupational competence. It was recommended that the hospital adopt an integrative intervention approach to the management of MDR- TB patients that include principles of psychosocial rehabilitation and occupational enrichment to address occupational risk factors and institutionalisation.