Timely initiation of MDR-TB treatment: A descriptive qualitative study at primary health care facilities in a district of the Cape Metropole

Abstract

Timely initiation of Drug Resistant Tuberculosis (DR-TB) treatment is essential for an effective TB control programme. Delays in initiating DR-TB treatment increase the risk of death and transmission of DR-TB within communities. DR-TB is diagnosed using GeneXpert testing, results are available to the local clinics within twenty four hours and DR-TB services have been decentralised to Primary Health Care Facilities to potentially reduce the length of time taken to initiate DR-TB treatment. However, it has been reported that despite these efforts, a large number of patients fail to initiate DR-TB treatment. Direct transmission is becoming the main driver of new DR-TB infections in the Western Cape and late initiation of treatment contributes to the spread of DR-TB within the community. The aim of the study is to explore the factors influencing whether newly diagnosed DR-TB patients initiate treatment on time at Primary Health Care facilities within the Mitchell's Plain sub-district. A descriptive qualitative research design was used. Semi-structured interviews were conducted in English with 16 purposefully sampled patients from two facilities in the Mitchell's Plain sub district were diagnosed with DR-TB. The patient sample consists of some patients who initiated treatment within five days from the date of sputum collection and some patients who initiated treatment more than five days from the date of sputum collection. Interviews were also conducted with health care workers from the health facilities. Data was collected using a digital recorder and field notes. The data was analysed using Thematic Coding Analysis and emerging themes were obtained. Ethical approval was sought from the University of the Western Cape Senate Research Committee and permission to conduct studies at the facilities was sought from the City of Cape Town. Informed consent was sought from participants.