The feasibility of a model for innovative care of Tuberculosis patients at an urban clinic in the Eastern Cape Province of South Africa: A qualitative assessment

Abstract

In this mini-thesis, I used qualitative methods to assess the feasibility of implementing a multi faceted intervention designed to improve tuberculosis treatment adherence in an urban primary health care setting in the Eastern Cape Province of South Africa. Non-adherence to tuberculosis (TB) treatment is a major factor contributing to poor treatment outcome and programme performance especially in an era of health system transformation. TB is a chronic disease requiring continuity of care to support a patient centred approach. Multi-faceted interventions have been found to be more effective in changing behaviour than single faceted interventions. The behaviour of both patients and health provider staff needs to be supported in order to attain therapeutic goals. Unfortunately only very few studies have been done in this area. This multi-faceted intervention design was based on social learning behavioural theory to support a patient-centred care approach. The intervention comprised reorientation training of health provider staff, a patient- adherence interview, a hand-held coutext-specific picture story educational novella, a system of packed TB medication and trained TB treatment supporters, as a package of care. I used purposive sampling to identify subjects for in-depth interviews. Three focus group discussions were held, one each with volunteer TB treatment supporters, patients on clinic-based treatment and patients on community-based treatment. Finally a clinic observation study was done to verify health provider practices. The results were then triangulated and a thematic analysis done to identify facilitating factors and barriers to the implementation of this intervention. The results were then triangulated and a thematic analysis done to identify facilitating factors and barriers to the implementation of this intervention. The intervention was well received by both health provider staff and patients. It was implemented with some difficulty. The patient-adherence interview was found to be the most difficult to implement successfully. I found this tailored multi-faceted intervention feasible to implement with more careful training and imp lementation of the patient-adherence interview required. The intervention was well received by both health provider staff and patients. It was implemented with some difficulty. The patient-adherence interview was found to be the most difficult to implement successfully. I found this tailored multi-faceted intervention feasible to implement with more careful training and imp lementation of the patient-adherence interview required.