Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa
Principal Investigator(s): View help for Principal Investigator(s) Jason Farley, Johns Hopkins University School of Nursing
Version: View help for Version V1
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Project Citation:
Farley, Jason. Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2017-07-21. https://doi.org/10.3886/E100857V1
Project Description
Summary:
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Background:
Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).
Methods:
We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.
Findings:
The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p=NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.
Interpretation:
Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care.
Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).
Methods:
We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.
Findings:
The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p=NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.
Interpretation:
Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care.
Funding Sources:
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Centers for Disease Control and Prevention (CDC) (5U2GPS002062-05)
Scope of Project
Subject Terms:
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MDR-TB;
HIV;
task-sharing;
task-shifting;
nurse-initiated
Geographic Coverage:
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KwaZulu Natal, South Africa
Time Period(s):
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1/3/2012 – 12/31/2012
Collection Date(s):
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1/5/2015 – 5/31/2015
Universe:
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Treatment Outcomes of MDR-TB patients managed by nurse practitioners
Data Type(s):
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clinical data;
medical records;
observational data
Collection Notes:
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N/A
Methodology
Response Rate:
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As this was a retrospective study with an informed consent waiver, 100% of the patients medical records were available for data record review.
Sampling:
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Convenience sampling of all MDR-TB patients presenting to the study site, 18 years of age and older.
Data Source:
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South African paper medical records
Collection Mode(s):
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record abstracts
Scales:
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Standardized medical record documentation for the South African DR-TB program
Weights:
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N/A
Unit(s) of Observation:
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Individuals
Geographic Unit:
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Other
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