Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Taking into consideration the long duration of standard treatment for Mycobacterium
tuberculosis (TB), the high prevalence of HIV co-infection and the growing prevalence of
drug-resistant TB, there is an urgent need for improved treatment approaches for TB and
HIV. However, there is inadequate information regarding the burden being placed on the
Department of Health (DOH) systems by the current treatment of patients established on
Antiretroviral Therapy (ART) who are newly diagnosed with TB, and by their clinical
management.
The aim of the study was to determine what proportion of patients established on ART
were newly diagnosed with TB, and what their clinical and treatment outcomes were in
different public sector settings in the eThekwini Region, KwaZulu-Natal (KZN). Approval
for the study was obtained from the Human Research Committee of Stellenbosch
University and from the Biomedical Research Committee, KZN.
The study used a retrospective, quantitative, cohort technique at both TB and ART clinics
at three sites in the eThekwini region, KZN. These sites were DOH clinics and were
selected as they all had a TB clinic and a DOH-registered ART clinic. The study focused
on a period of one year prior to a patient established on ART developed TB. The study
population comprised all TB patients who attended the selected DOH clinics.
A data collection tool was developed and pilot-tested. A small sample of patient files
(n=15, representing 2% of the study population) was randomly selected; five from each
site. The files and data were excluded from the main study.
A total of 1824 files (579 from the TB clinics and 1245 from the ART clinics) were
reviewed. The data were captured into an electronic database (EpiData Version 3.3) and
analyzed using STATA (Version 11.0) with the assistance of a statistician. The findings show that of the study sample from the TB clinics (N=579), 78% (454/579)
were newly diagnosed with TB. Of the new TB cases, 90% (409/454) had pulmonary TB
and 71% (413/579) were HIV-positive. Nearly 50% (68/137) of the patients had
commenced ART prior to TB diagnosis and treatment, and 14% (19/137) had commenced
ART after TB. Of those who commenced ART prior to TB diagnosis and treatment, 29%
(20/68) had commenced ART more than three months prior to acquiring TB. The findings from the ART clinics show that of the files (N=1245) reviewed, 40%
(501/1245) had TB, and of these 8% (42/501) developed TB after three months or more of
ART.
Missing data in the patient medical files was a major challenge. The lack of recorded data
about ART in the TB clinics and about TB in the ART clinics suggests suboptimal clinical
management and poor integration of HIV and TB services. It was therefore not possible to
derive a combined HIV-TB outcome measure.
Recommendations to promote and implement the integration of TB and HIV services
included policy changes and implementation, management and practice suggestions,
education and training to integrate TB/HIV services and increase research to identify gaps
in clinical management and to improve integration of services. / AFRIKAANSE OPSOMMING: Met inagneming van die lang duur van die standaard behandeling vir Mycobacterium
tuberkulose (TB), hoë voorkoms van MIV-infeksie en die groeiende voorkoms van
dwelmweerstandige TB, is daar ’n dringende behoefte aan verbeterde
behandelingbenaderings vir TB en MIV. Daar is egter ’n gebrek aan inligting oor die las
geplaas op die Departement van Gesondheid (DvG) se stelsels deur die huidige
behandeling van pasiënte op antiretrovirale terapie (ART) wat gediagnoseer is met TB en
deur hul kliniese bestuur.
Die doel van die studie was om vas te stel watter persentasie van pasiënte wat op ART
gevestig is, wel met TB gediagnoseer is, en wat hul kliniese en behandeling-uitkomste was
in verskillende openbare-sektorinstellings in die eThekwini-streek, KwaZulu-Natal (KZN).
Goedkeuring vir die studie is verkry van die Menslike Navorsingskomitee van die
Universiteit van Stellenbosch en van die Biomediese Navorsingskomitee, KZN.
Die studie het gebruik gemaak van ’n retrospektiewe, kwantitatiewe ‘cohort’-tegniek by
beide TB en ARB-klinieke op drie plekke in die eThekwini-streek, KZN. Hierdie terreine
was DvG-klinieke en is gekies omdat hulle almal oor ’n TB-kliniek en 'n DvGgeregistreerde
ART-kliniek beskik. Die studie het gefokus op ’n tydperk van een jaar voor
’n pasiënt wat op ART is, TB ontwikkel het. Die studiepopulasie bestaan uit alle TBpasiënte
wat die geselekteerde DvG-klinieke bygewoon het. ’n Data-insamelinginstrument is ontwikkel en getoets. ’n Klein voorbeeld van die
pasiëntlêers (n = 15, 2% van die studie bevolking verteenwoordig) is ewekansig gekies:
vyf uit elke plek, en die data is vervat in ’n elektroniese databasis (EpiData Version 3,3).
’n Totaal van 1824 lêers (579 in die TB-klinieke en 1245 lêers in die ART-klinieke) is
ondersoek. Die data is ontleed deur gebruik te maak van Stata (weergawe 11,0) met die
hulp van ’n statistikus. Die bevindinge toon dat van die studiemonster in die TB-klinieke (N = 579), 78% (454/579)
met TB gediagnoseer is. Van die nuwe TB-gevalle, het 90% (409/454) pulmonêre TB
gehad en was 71% (413/579) MIV-positief. Byna 50% (68/137) van die pasiënte het ART
begin vóór hulle TB-diagnose en -behandeling, en 14% (19/137) ART ná TB. Van dié wat
ART voor TB-diagnose en -behandeling begin het, het 29% (20/68) meer as drie maande
voor die opdoen van TB met ART begin. Die bevindinge van die ART-klinieke toon dat van
die lêers (N = 1245) wat bestudeer is, 40% (501/1245) TB het, en hiervan het 8% (42/501)
TB na drie of meer maande van ART ontwikkel.
Ontbrekende data in die pasiënt se mediese lêers was ’n groot uitdaging. Die gebrek aan
aangetekende data oor ART in die TB-klinieke en oor TB in die ART-klinieke dui op
suboptimale kliniese bestuur en swak integrasie van MIV- en TB-dienste. Dit was dus nie
moontlik om ’n gesamentlike MIV-TB uitkomsmaatreël af te lei nie.
Aanbevelings om die integrasie van TB- en MIV-dienste te bevorder en te implementer,
het beleidveranderinge en -implementering ingesluit, asook bestuur- en praktykvoorstelle,
onderwys en opleiding om TB-/MIV-dienste by DvG-vlak te integreer en meer navorsing
om gapings in die kliniese bestuur te identifiseer en die integrasie van dienste te verbeter.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/80334 |
| Date | 03 1900 |
| Creators | Veerasami, Sowbagium |
| Contributors | Marais, Frederick, Pym, Alex, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
| Format | 123 p. |
| Rights | Stellenbosch University |
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