ArticleBMJ open2020
Provider perspectives of the introduction and implementation of care for drug-resistant tuberculosis patients in district-level facilities in South Africa: a qualitative study.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Exploring lived experiences of nurses in managing patients with drug-resistant tuberculosis in Western Amhara, Northwest Ethiopia: a descriptive phenomenological study.BMC health services research · 2025Article
- Decentralising DR-TB care: the trade-off between quality of care and service coverage in the early phase of implementation.Public health action · 2025Article
- The effects of decentralisation on patient and service outcomes: a case of the 2018 decentralisation of multidrug-resistant tuberculosis in Zambia.Archives of public health = Archives belges de sante publique · 2025Article
- Actor sensemaking and its role in implementation of the decentralized drug-resistant tuberculosis policy in South Africa.Health policy and planning · 2025Article
- Drug-Resistant Tuberculosis Hotspots in Oliver Reginald Tambo District Municipality, Eastern Cape, South Africa.Infectious disease reports · 2024Article
- Travel distance to rifampicin-resistant tuberculosis treatment and its impact on loss to follow-up: the importance of continued RR-TB treatment decentralization in South Africa.BMC public health · 2024Article
- Drug-resistant tuberculosis: integrative review of nursing care in primary health care.Revista brasileira de enfermagem · 2024Review
- Health system determinants of tuberculosis mortality in South Africa: a causal loop model.BMC health services research · 2021Article
- 'We had to manage what we had on hand, in whatever way we could': adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa.Health policy and planning · 2021Article
- A threat to decentralised care for drug-resistant tuberculosis.The Lancet. Respiratory medicine · 2020Article
- Drug-Resistant Tuberculosis Stigma Among HealthCare Workers Toward the Development of a Stigma-Reduction Strategy: A Scoping Review.Inquiry : a journal of medical care organization, provision and financingArticle
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Authors and funding
4 authors.
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Abstract
objectivesDrug-resistant tuberculosis (DR-TB) is a growing concern in many low-income and middle-income countries. Facing rising numbers of DR-TB patients, South Africa (SA) introduced a decentralised model of care for DR-TB in 2011. We aimed to document the introduction and implementation of the new models of care for patients with DR-TB in four provinces (Northern Cape, KwaZulu-Natal, Eastern Cape and Gauteng) in 2015 using mixed methods, including interviews, register reviews and clinical audits. This paper reports on the qualitative component of the study.
designThis is a qualitative interview study.
settingData were collected in 22 decentralised DR-TB sites, primary healthcare facilities and district hospitals and one provincial central DR-TB hospital.
participants58 healthcare workers (HCWs), facility staff and provincial and district TB coordinators were included in qualitative interviews.
resultsHCWs felt that the introduction of DR-TB care in their facility came with little warning or engagement, creating fear and anxiety. They expressed a need for support from the district and province to guide them through the changes but this support was often lacking. In addition, many respondents expressed feeling isolated and not supported by other healthcare providers which they feel impacts on the quality of the care they provide.
conclusionIntroduction of a new service such as DR-TB care can be difficult and does not always result in the intended outcomes. Improved engagement with front-line providers and addressing the fear and anxiety that may be raised by changes in daily practices should be addressed to ensure successful implementation and prevent negative consequences that can hamper quality of care for patients. Attention should be paid to how the decentralised DR-TB unit can be supported by district management and other healthcare providers.
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