Top

Published in:

Open Access 01-12-2024 | Tuberculosis | Research

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

Authors: Katherine C. McNabb, Alanna J. Bergman, Amita Patil, Kelly Lowensen, Nomusa Mthimkhulu, Chakra Budhathoki, Nancy Perrin, Jason E. Farley

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

Understanding why patients experience loss to follow-up (LTFU) is essential for TB control. This analysis examines the impact of travel distance to RR-TB treatment on LTFU, which has yet to be analyzed within South Africa.

Methods

We retrospectively analyzed 1436 patients treated for RR-TB at ten South African public hospitals. We linked patients to their residential ward using data reported to NHLS and maps available from the Municipal Demarcation Board. Travel distance was calculated from each patient’s ward centroid to their RR-TB treatment site using the georoute command in Stata. The relationship between LTFU and travel distance was modeled using multivariable logistic regression.

Results

Among 1436 participants, 75.6% successfully completed treatment and 24.4% were LTFU. The median travel distance was 40.96 km (IQR: 17.12, 63.49). A travel distance > 60 km increased odds of LTFU by 91% (p = 0.001) when adjusting for HIV status, age, sex, education level, employment status, residential locale, treatment regimen, and treatment site.

Conclusion

People living in KwaZulu-Natal and Eastern Cape travel long distances to receive RR-TB care, placing them at increased risk for LTFU. Policies that bring RR-TB treatment closer to patients, such as further decentralization to PHCs, are necessary to improve RR-TB outcomes.

World Health Organization. Global Tuberculosis Report 2022 [Internet]. Geneva, Switzerland: World Health Organization; 2022. Available from: https://www.who.int/publications/i/item/9789240061729.

World Health Organization. Tuberculosis: Multidrug-resistant tuberculosis (MDR-TB) [Internet]. 2018. Available from: https://www.who.int/news-room/questions-and-answers/item/tuberculosis-multidrug-resistant-tuberculosis-(mdr-tb).

Franke MF, Appleton SC, Bayona J, Arteaga F, Palacios E, Llaro K, et al. Risk Factors and Mortality Associated with Default from Multidrug-Resistant Tuberculosis Treatment. Clin Infect Dis. 2008;46(12):1844–51.CrossRefPubMed

Memani B, Beko B, Dumile N, Mohr-Holland E, Daniels J, Sibanda B, et al. Causes of loss to follow-up from drug-resistant TB treatment in Khayelitsha. South Africa Public Health Action. 2022;12(2):55–7.CrossRefPubMed

Ndjeka N, Campbell JR, Meintjes G, Maartens G, Schaaf HS, Hughes J, et al. Treatment outcomes 24 months after initiating short, all-oral bedaquiline-containing or injectable-containing rifampicin-resistant tuberculosis treatment regimens in South Africa: a retrospective cohort study. Lancet Infect Dis. 2022;22(7):1042–51.CrossRefPubMedPubMedCentral

World Health Organization. Global Tuberculosis Report 2013 [Internet]. Geneva, Switzerland: World Health Organization; 2013. Available from: https://www.who.int/publications/i/item/9789241564656.

World Health Organization. Tuberculosis Profile: South Africa [Internet]. 2022. Available from: https://worldhealthorg.shinyapps.io/tb_profiles/.

McNabb KC, Bergman A, Farley JE. Risk factors for poor engagement in drug-resistant TB care in South Africa: a systematic review. Public Health Action. 2021;11(3):139–45.CrossRefPubMedPubMedCentral

South African National Department of Health. Multi-drug resistant tuberculosis: A policy framework on decentralised and deinstitutionalized management for South Africa. [Internet]. Pretoria: South Africa: South African National Department of Health.; 2019. Available from: https://www.health.gov.za/wp-content/uploads/2020/11/policy-framework-on-decentralised-management-of-mdr-tb-may-2019_compressed.pdf.

10.

Vanleeuw L, Atkins S, Zembe-Mkabile W, Loveday M. Provider perspectives of the introduction and implementation of care for drug-resistant tuberculosis patients in district-level facilities in South Africa: a qualitative study. BMJ Open. 2020;10(2): e032591.CrossRefPubMedPubMedCentral

11.

Mitrani L, Dickson-Hall L, Le Roux S, Hill J, Loveday M, Grant AD, et al. Diverse clinical and social circumstances: developing patient-centred care for DR-TB patients in South Africa. Public Health Action. 2021;11(3):120–5.CrossRefPubMedPubMedCentral

12.

Mohr E, Snyman L, Mbakaz Z, Caldwell J, DeAzevedo V, Kock Y, et al. “Life continues”: Patient, health care and community care workers perspectives on self-administered treatment for rifampicin-resistant tuberculosis in Khayelitsha, South Africa. Shewade HD, editor. PLOS ONE. 2018;13(9).CrossRefPubMedPubMedCentral

13.

Meeting report of the WHO expert consultation on the definition of extensively drug-resistant tuberculosis, October 27–29, 2020 [Internet]. Geneva, Switzerland: World Health Organization; 2021. Available from: https://www.who.int/publications/i/item/9789240018662.

14.

Farley JE, Kelly AM, Reiser K, Brown M, Kub J, Davis JG, et al. Development and Evaluation of a Pilot Nurse Case Management Model to Address Multidrug-Resistant Tuberculosis (MDR-TB) and HIV in South Africa. Almeida A, editor. PLoS ONE. 2014;9(11):e111702.ADSCrossRefPubMedPubMedCentral

15.

National Health Laboratory Service [Internet]. Available from: https://www.nhls.ac.za/.

16.

Municipal Demarcation Board. Ward Delimitation 2016 [Internet]. South Africa; Available from: https://www.demarcation.org.za/ward-delimitation-2011-and-2016/.

17.

Google Maps [Internet]. Available from: https://google.com/maps/.

18.

HereWeGo [Internet]. Available from: https://wego.here.com.

19.

Weber S, Péclat M, Warren A. Travel distance and travel time using Stata: New features and major improvements in georoute. Stata J Promot Commun Stat Stata. 2022;22(1):89–102.CrossRef

20.

StataCorp. Stata Statistical Software: Release 16 [Internet]. College Station: Texas; 2019. Available from: StataCorp LLC.

21.

Barker RD, Nthangeni ME, Millard FJ. Is the distance a patient lives from hospital a risk factor for death from tuberculosis in rural South Africa? Int J Tuberc Lung Dis. 2022;6(2):98–103.

22.

Bhering M, Duarte R, Kritski A. Predictive factors for unfavourable treatment in MDR-TB and XDR-TB patients in Rio de Janeiro State, Brazil, 2000–2016. Escobar-Gutiérrez A, editor. PLOS ONE. 2019;14(11).CrossRefPubMedPubMedCentral

23.

Olupot B, Adrawa N, Bajunirwe F, Izudi J. HIV infection modifies the relationship between distance to a health facility and treatment success rate for tuberculosis in rural eastern Uganda. J Clin Tuberc Mycobact Dis. 2021;23: 100226.

24.

Schoenbaechler V, Guilavogui Y, Onivogui S, Hébélamou J, Mugglin C, Furrer H, et al. Rate of treatment success and associated factors in the program for drug-susceptible tuberculosis in the Forest Region, Republic of Guinea, 2010–2017: A real-world retrospective observational cohort study. Int J Infect Dis. 2021;110:6–14.CrossRefPubMed

25.

Robsky KO, Hughes S, Kityamuwesi A, Kendall EA, Kitonsa PJ, Dowdy DW, et al. Is distance associated with tuberculosis treatment outcomes? A retrospective cohort study in Kampala, Uganda. BMC Infect Dis. 2020;20(1):406.CrossRefPubMedPubMedCentral

26.

Obsa MS, Daga WB, Wosene NG, Gebremedhin TD, Edosa DC, Dedecho AT, et al. Treatment seeking delay and associated factors among tuberculosis patients attending health facility in Ethiopia from 2000 to 2020: A systematic review and meta analysis. Quinn F, editor. PLOS ONE. 2021;16(7):e0253746.CrossRefPubMedPubMedCentral

27.

Kim HW, Park S, Min J, Sun J, Shin AY, Ha JH, et al. Hidden loss to follow-up among tuberculosis patients managed by public–private mix institutions in South Korea. Sci Rep. 2022;12(1):12362.ADSCrossRefPubMedPubMedCentral

28.

Sarangi SS, Dutt D. Risk factors associated with default among retreatment tuberculosis patients on DOTS in Paschim Medinipur district (West Bengal). Indian J Tuberc. 2014;61(3):213–23.PubMed

29.

Secretary Of Jan Swasthya Sahyog, Laux TS, Patil S. Predictors of tuberculosis treatment outcomes among a retrospective cohort in rural, Central India. J Clin Tuberc Mycobact Dis. 2018;12:41–7.

30.

Ruru Y, Matasik M, Oktavian A, Senyorita R, Mirino Y, Tarigan LH, et al. Factors associated with non-adherence during tuberculosis treatment among patients treated with DOTS strategy in Jayapura, Papua Province, Indonesia. Glob Health Action. 2018;11(1):1510592.CrossRefPubMedPubMedCentral

31.

Marahatta SB, Yadav RK, Giri D, Lama S, Rijal KR, Mishra SR, et al. Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers. Kamolz LP, editor. PLOS ONE. 2020;15(1):e0227293.CrossRefPubMedPubMedCentral

32.

Appiah MA, Arthur JA, Gborgblorvor D, Asampong E, Kye-Duodu G, Kamau EM, et al. Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective. BMC Public Health. 2023;23(1):1317.CrossRefPubMedPubMedCentral

33.

Anderson De Cuevas RM, Al-Sonboli N, Al-Aghbari N, Yassin MA, Cuevas LE, Theobald SJ. Barriers to Completing TB Diagnosis in Yemen: Services Should Respond to Patients’ Needs. Dowdy DW, editor. PLoS ONE. 2014;9(9):105194.

34.

McKenzie A, Schneider H, Schaay N, Scott V, Sanders D. Primary health care systems (PRIMASYS): case study from South Africa [Internet]. Geneva, Switzerland: World Health Organization; 2017. Available from: https://ahpsr.who.int/publications/i/item/primasys-comprehensive-case-study-from-south-africa.

35.

World Health Organiaztion. WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update [Internet]. Geneva, Switzerland: World Health Organization; 2022. Available from: https://www.who.int/publications/i/item/9789240063129.

36.

Farley JE, Ndjeka N, Kelly AM, Whitehouse E, Lachman S, Budhathoki C, et al. Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa. Ito E, editor. PLOS ONE. 2017;12(8):e0182780.CrossRefPubMedPubMedCentral

37.

Farley JE, Ndjeka N, Mlandu K, Lowensen K, Geiger K, Nguyen Y, et al. Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: inter-professional training and task-sharing considerations. Hum Resour Health. 2021;19(1):6.CrossRefPubMedPubMedCentral

38.

Edessa D, Sisay M, Dessie Y. Unfavorable outcomes to second-line tuberculosis therapy among HIV-infected versus HIV-uninfected patients in sub-Saharan Africa: A systematic review and meta-analysis. Yu Q, editor. PLOS ONE. 2020;15(8):e0237534.CrossRefPubMedPubMedCentral

39.

Schnippel K, Firnhaber C, Berhanu R, Page-Shipp L, Sinanovic E. Adverse drug reactions during drug-resistant TB treatment in high HIV prevalence settings: a systematic review and meta-analysis. J Antimicrob Chemother. 2017;72(7):1871–9.CrossRefPubMed

40.

Bergman A, McNabb KC, Akumbom A, Mlandu K, Flores DD. Identity management in the face of intersecting stigmas: A Metasynthesis of Qualitative Reports from Subsaharan Africa. 24th International AIDS Conference; 2022; Montreal, Canada.

41.

Bartholomay P, Pinheiro RS, Dockhorn F, Pelissari DM, De Araújo WN. Brazilian cohort study of risk factors associated with unsuccessful outcomes of drug resistant tuberculosis. BMC Infect Dis. 2021;21(1):1049.CrossRefPubMedPubMedCentral

42.

Kendall EA, Theron D, Franke MF, Van Helden P, Victor TC, Murray MB, et al. Alcohol, Hospital Discharge, and Socioeconomic Risk Factors for Default from Multidrug Resistant Tuberculosis Treatment in Rural South Africa: A Retrospective Cohort Study. Pai M, editor. PLoS ONE. 2013;8(12):e83480.ADSCrossRefPubMedPubMedCentral

43.

Gajee R, Schnippel K, Mthupha N, Muzah B, Berhanu R. Missed appointments among rifampicin-resistant tuberculosis (RR-TB) patients at a decentralised RR-TB outpatient clinic in Johannesburg, South Africa. S Afr Med J. 2016;106(9):912.CrossRefPubMed

44.

Tupasi TE, Garfin AMCG, Kurbatova EV, Mangan JM, Orillaza-Chi R, Naval LC, et al. Factors Associated with Loss to Follow-up during Treatment for Multidrug-Resistant Tuberculosis, the Philippines, 2012–2014. Emerg Infect Dis. 2016;22(3):491–502.CrossRefPubMedPubMedCentral

45.

South African National Department of Health. Multi-drug resistant tuberculosis: A policy framework on decentralised and deinstitutionalized management for South Africa. [Internet]. Pretoria: South Africa: South African National Department of Health.; 2011. Available from: https://www.hst.org.za/publications/NonHST%20Publications/SA-MDR-TB-Policy.pdf.

Title: 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
Authors: Katherine C. McNabb
Alanna J. Bergman
Amita Patil
Kelly Lowensen
Nomusa Mthimkhulu
Chakra Budhathoki
Nancy Perrin
Jason E. Farley
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Tuberculosis
Tuberculosis
Human Immunodeficiency Virus
Rifampicin
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-17924-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Assessing the relationship between nutrition literacy and eating behaviors among nursing students: a cross-sectional study

Psychometric evaluation of the Chinese version of the stressors in breast cancer scale: a translation and validation study

The influencing factors of hearing protection device usage among noise-exposed workers in Guangdong Province: a structural equation modeling-based survey

Social and behavior change communication competency among front-line healthcare system actors in Ethiopia: a cross-sectional study

Prevalence trends of anemia impairment in adolescents and young adults with HIV/AIDS

The interaction between general or abdominal obesity and hypertension on the risk of type 2 diabetes mellitus: a cross-sectional analysis in Iranian adults from the RaNCD cohort study