Stop TB Partnership

Addressing Drug-Resistant TB in North West Province, South Africa through Decentralized Care and Treatment Services

27 January 2015 - In South Africa, the traditional model of care for MDR TB involves hospitalizing MDR TB patients during the intensive phase of their treatment (6-8 months) to ensure proper administration and adherence to treatment and to limit transmission. However, this model often results in bed shortages, delays in treatment initiation for MDR TB patients, a high likelihood of transmission of MDR/XDR TB at health facilities, and lack of social support for patients, who are isolated from their families during treatment and who may face financial burdens due to the lengthy hospital stays.

The USAID TB Program South Africa is assisting the National Department of Health to implement the DR-TB Patient-Centred Model of Care to increase case detection and improve DR-TB treatment outcomes, thereby reducing further DR-TB transmission. The model is based on the understanding that good clinical practice, consistent documentation of data, and two-way communication between operational and clinical managers, leads to improving the quality of DR-TB programs.

In January 2015, USAID TB Program South Africa attended a launch event celebrating the official opening of functional decentralized DR treatment sites in Bojanala and Ngaka Modiri Molema districts in North West Province. North West is only the second province, after Kwa-Zulu Natal, to achieve full realization of DR TB decentralization, which was accomplished through a sustained and committed partnership with the USAID TB Program South Africa over the past three years. In November 2014, the first 90 stable MDR TB patients were down-referred to the JST Hospital Rustenburg in Bojanala District. The hospital is also now currently initiating newly-diagnosed MDR TB cases onto treatment. In Ngaka Modiri Molema District, 43 MDR TB patients were down-referred to the decentralized site at Gerlukspan Hospital. A ceremony was held for these patients, welcoming them to the new site closer to their homes and to encourage them to adhere to treatment.

Decentralization Process

Identification and Training of Doctors: Since 2011, USAID TB Program South Africa has partnered with the International Union against TB and Lung Disease to deliver DR TB training to doctors and develop trainer-of-trainers (TOTs) to prepare districts for DR TB decentralization. Thirty (30) doctors from North West Province attended a three-day DR training workshop facilitated by the Union.

Facility Readiness Assessments: USAID TB Program South Africa conducted facility readiness assessments to determine the feasibility of various health facilities in North West to support decentralized TB services. Following the initial assessments, quality improvement plans for each facility were developed to help them attain the minimum requirements to support decentralization.

District Workshops: USAID TB Program South Africa also conducted two-day workshops for district-level managers to develop standard operating procedures for activating decentralized sites. During these workshops, districts agreed on the process for down referral of DR TB patients and a framework for monitoring and evaluating the decentralized sites. USAID TB Program South Africa is also assisting the districts in establishing district-level Clinical Review and Pharmacovigilance Committees, which will be responsible for oversight of the decentralized program, including monitoring patient treatment outcomes and adverse effects.

MDR-TB patients in North West Province, South Africa are now able to access treatment at decentralized facilities closer to their homes and communities.