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DR-TB Patient Centered Care Package

The USAID TB South Africa Project contributes to efforts aimed at reaching global consensus on a package of essential DR-TB patient-centred services, and to translate that consensus into practical and flexible tools by piloting a cutting-edge approach in Eastern Cape, Free State and Limpopo provinces. The process was officially launched in July 2017.

This process follows from the December 2015 White House official release of a plan to address multidrug-resistant tuberculosis (MDR-TB) domestically and internationally through implementation of a National Action Plan (NAP) for Combating MDR-TB. The NAP builds on the World Health Organization’s (WHO) End TB Strategy and United States Government domestic and global TB strategies. It also aims to contribute to the successes of existing strategies to eliminate MDR-TB. South Africa is amongst one of four countries (including China, Pakistan and Ukraine) identified as sites for Phase I, which aims to develop and implement a patient-centred DR-TB package of care as part of efforts to meet targets in the NAP.

While South Africa demonstrates improvements in access to DR-TB treatment and care, in part by increasing the number of treatment sites from 17 in 2011 to 664 in 2016, at 57% the treatment success rate for MDR-TB in the country is still unacceptably low. This figure is however, marginally higher than the approximate global average of 50%.

Implementation of the drug-resistant tuberculosis DR TB patient centered care service package in South Africa

The project continues to lead efforts in implementing a standardized package of essential drug-resistant TB (DR-TB) patient-centered services to improve the quality of DR-TB care and positively impact treatment success rates. Towards this end, USAID developed A Practical Guide to Delivering Essential Supportive Care to Patients with Drug-resistant Tuberculosis.

Using this, we adopted and piloted the DR-TB care service package in Eastern Cape, Free State and Limpopo provinces (three of the nine provinces of the country) starting in July 2017. By December 2017, the project had enrolled 200 patients with DR-TB onto the package, which aims to address barriers mentioned above, by providing a patient-centered care package, and assessing whether this practically translates into better treatment outcomes.

Provincial DR-TB treatment sites were allocated to the intervention and control groups of the pilot. In the control sites all patients diagnosed with DR-TB between July and December 2017 received standard services. All eligible patients seen during this period were provided with a treatment care package, in addition to standard DR-TB services.

The package includes:

  • Health education package
  • Patient and family education
  • Nutritional support
  • Psychosocial support
  • Monitoring and timely treatment of side effects and adverse drug reactions
  • Regular monitoring and treatment of mental health conditions
  • Reduction of social isolation and provide emotional support
  • Protection from stigma and discrimination
  • Transport assistance through provision of social grants

The DR-TB care package is being rolled out by nurse coordinators, social workers and project-funded NGOs in supported areas.