Strategies used to implement the national guidelines on preventing and early management of multi-drug resistant tuberculosis (MDR-TB) at the Buffalo City Municipality clinics in East London Eastern Cape Province.

Abstract

The purpose of the study was to explore and describe the strategies used by nurses to implement the national treatment guidelines to prevent, detect and manage multi-drug resistant tuberculosis (MDR-TB) patients. Tuberculosis remains one of the leading infectious diseases and the major cause of death worldwide with estimates of 9.2 million new TB cases in 2008 and 1.7 deaths including 200 000 in clients co-infected with HIV. South Africa is currently ranked 3rd among the 22 high TB burden countries in the world. The HIV/AIDS epidemic contributes significantly to the upward trend in TB morbidity and it is estimated that more than 50% of TB patients are also HIV positive (South African Department of Health 2009:10). The current rate of tuberculosis infections as a result of new infections as well as re-infections of patients is of concern to the disease control and policy making bodies of South Africa. Questions regarding the effectiveness of tuberculosis policies and programmes emerge at all times (Luhulima, Netshandama and Davhana-Maselesele, 2008: 36). Patients with multidrug-resistant (MDR) tuberculosis (TB) are at high risk of treatment failure. It is anticipated that early identification of MDR-TB and appropriate treatment will improve patient outcome and disease control. This study intends to explore the effectiveness of health systems in the prompt identification and management of MDR patients. This study was conducted using a qualitative, explorative and descriptive design. A purposive sample of clinics and professional nurses was selected, and voluntary participation was ensured. The data was collected through individual interviews which were audio taped and then transcribed verbatim. Findings revealed that MDR-TB guidelines were available at the clinics. The professional nurses implemented the guidelines to prevent, detect and manage multi-drug resistant tuberculosis, by screening and testing symptomatic high risk groups, contact tracing and monitoring, providing initial counselling and education to patients and family, preparing patients for admission when indicated and coordinating referrals to the centralised MDR-TB unit. However, there were notable constraints with regards to the management of MDR-TB patients and the overall TB programme. These included MDR-TB specific training, staff shortages, dysfunctional community DOT programme, shortage of beds at the MDR-TB treatment centres, and patient factors like defaulting, migration for various reasons, alcoholism. All these constraints call for intensified strategic management at both policy and facility level. It is also necessary that all policies related to patient management need extensive scientific study to monitor and evaluate their effectiveness. More research studies are required on policy analysis and utilization.