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Browsing by Author "Roberts, Jacquelin."

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    Association between health systems performance and treatment outcomes in patients co-infected with MDR-TB and HIV in KwaZulu-Natal, South Africa: implications for TB programmes.
    (Public Library of Science., 2014) Loveday, Marian Patricia.; Padayatchi, Nesri.; Wallengren, Kristina.; Roberts, Jacquelin.; Brust, James C. M.; Ngozo, Jacqueline.; Master, Iqbal.; Voce, Anna Silvia.
    Objective: To improve the treatment of MDR-TB and HIV co-infected patients, we investigated the relationship between health system performance and patient treatment outcomes at 4 decentralised MDR-TB sites. Methods: In this mixed methods case study which included prospective comparative data, we measured health system performance using a framework of domains comprising key health service components. Using Pearson Product Moment Correlation coefficients we quantified the direction and magnitude of the association between health system performance and MDR-TB treatment outcomes. Qualitative data from participant observation and interviews analysed using systematic text condensation (STC) complemented our quantitative findings. Findings: We found significant differences in treatment outcomes across the sites with successful outcomes varying from 72% at Site 1 to 52% at Site 4 (p<0.01). Health systems performance scores also varied considerably across the sites. Our findings suggest there is a correlation between treatment outcomes and overall health system performance which is significant (r = 0.99, p<0.01), with Site 1 having the highest number of successful treatment outcomes and the highest health system performance. Although the 'integration' domain, which measured integration of MDR-TB services into existing services appeared to have the strongest association with successful treatment outcomes (r = 0.99, p<0.01), qualitative data indicated that the 'context' domain influenced the other domains. Conclusion: We suggest that there is an association between treatment outcomes and health system performance. The chance of treatment success is greater if decentralised MDR-TB services are integrated into existing services. To optimise successful treatment outcomes, regular monitoring and support are needed at a district, facility and individual level to ensure the local context is supportive of new programmes and implementation is according to guidelines.
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    Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.
    (International Union Against Tuberculosis and Lung Disease., 2015) Loveday, Marian Patricia.; Wallengren, Kristina.; Brust, James C. M.; Roberts, Jacquelin.; Voce, Anna Silvia.; Margot, Bruce.; Ngozo, Jacqueline.; Master, Iqbal.; Cassell, Gail H.; Padayatchi, Nesri.
    Abstract available in pdf.