QMU working to strengthen
global health systems for
TB care
R
ESEARCHERS FROM THE
Institute of Global Health and
Development (IGHD) at QMU
have been awarded funding for a series
of projects examining how health
systems in South Africa and Latvia
might improve access and quality of
care for patients with tuberculosis (TB).
Known as a disease of the poor, TB
remains a significant cause of disease
and death globally. Failure to effectively
control the TB epidemic has resulted in
the rise of TB bacteria that are resistant
to the main drugs used in treatment.
These drug-resistant bacteria can then
be transmitted to others and although
treatment is available, it is lengthy,
complicated, expensive, and results in poor
patient outcomes.
There have been recent medical
advances, including a rapid diagnostic
test for drug resistant TB (DR-TB) which
has been rolled out across South Africa,
and a new drug Bedaquiline which has
the potential to dramatically improve the
effectiveness of DR-TB treatment. In order
to increase access and decrease delays
in starting treatment, these developments
are being delivered in a decentralised
manner through the country’s existing
health system.
In collaboration with the University of Cape
Town’s Department of Medical Microbiology,
IGHD at QMU has received funding from
the Joint Health Systems Research
Initiative, funded through the Economic and
Social Research Council, Department for
International Development, The Wellcome
Trust and the Medical Research Council,
to better understand the health systems
constraints and enablers for the successful
implementation of decentralized care for
DR-TB patients in South Africa.
IGHD project lead, Dr Karina Kielmann,
said: “There is huge diversity in the ways
and extent to which care for DR-TB is being
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QMYOU / Health & Rehabilitation
decentralized across health districts in
South Africa - and substantial variation in
the performance of the DR-TB program in
relation to key measures of success such as
linkage to appropriate care and treatment
outcomes. Our aim in this four-year project
is to undertake an in-depth analysis of the
health policy and systems context and to
identify factors that determine what kinds
of models are working to improve patient
outcomes, and why these models work,
across different settings.”
The Latvian project looks at issues
of access to care and adherence to TB
treatment for vulnerable individuals.
“Sticking with TB treatment is key to a
successful outcome for patients, and can
be a real challenge for individuals who
struggle with alcohol or drug dependency,
and who may lack social or financial
support to encourage positive health-
seeking behaviour,” says Dr Kielmann who
is working on this research with colleagues
at IGHD and at the London School of
Hygiene and Tropical Medicine.
“In collaboration with partners at the
Centre for Tuberculosis and Lung Disease,
based at Riga East Clinical Hospital, we
have developed and piloted a social risk
screening tool that will help us identify those
individuals likely to struggle with adherence
to treatment, as well as tailored adherence
support mechanisms for those patients
at risk of dropping out of treatment. In
both projects, we hope to contribute to
strengthening health systems to improve TB
patients’ pathway to care and outcomes.”
The project in Latvia is funded through the
European Centre for Disease Prevention
and Control (ECDC) and managed by the
World Health Communication Associates.
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“we hope to contribute
to strengthening health
systems to improve TB
patients’ pathway to care and
outcomes.”