Journal de la prévention et du contrôle des infections Libre accès

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Community Infection Control in the Context of Injection-Free Regimen and Decentralised Ambulatory Care: Six Month Follow of DR-TB Cases in Decentralised Facilities eThekwini District, South Africa

Joven Jebio Ongole, Sharon Fynn, Gregory Jagwe

Introduction: In July 2018, South Africa introduced the injection free bedaquiline based treatment regimen to replace the kanamycin-based regimen for Drug-Resistant (DR) TB. With support from the USAID Tb South Africa project, eThekwini district with the highest burden of DRTB in South Africa rapidly decentralised DR-TB care from an initial three centralised admission TB Hospitals to 18 peripheral districts, community health centres and clinics to improve access while focusing on ambulatory care as opposed to institutionalized hospital based care. The ambulatory model of care meant patients where managed within their households and thus communities while on treatment. An effective infection control in the household and community was implemented to prevent and control infections among families and close contacts. After six months, 98% of the patients remained in ambulatory care and no transmission recorded among close contacts. This publication shares interventions used and early outcomes from this intervention.

Methods: A DR-TB care package was developed and adapted to each of the identified decentralised facilities and implemented in three layers. This include an orientation package for facility leadership to ensure appropriate governance, leadership and management for DRTB care at facility level, DRTB care package for DRTB providers and facility teams (DRTB teams) and a DRTB service package for the community functionally linked to the facility interventions. Training, systems mentorship and support supervision were the main interventions implemented.

Results: Between Oct 2018-Mar 2019, 16 of the 18 decentralised sites in eThekwini district adapted the DRTB care package and constituted their DRTB teams. Within the six months a total of 142 patients were initiated on treatment of which 139 (98%) remained in ambulatory care by the end of March 2019. Three patients with advance disease died in the first month of enrolment. Of the 142 index patients, 211 contacts of were screened (44% at home 56% at the facilities), 85% of the patients culture converted in the first month, 3 contacts were diagnosed with TB (2 drug sensitive, 01 drug resistant). No transmission occurred in contacts after enrolment into DRTB care.

Conclusion: The possibility of transmission of infection to DRTB contacts exist among patients placed in ambulatory care. However, among the patients that was provided with the DRTB care package in eThekwini District there was no transmission associated with the index patients. It is thus recommended that infection control interventions that starts from facility is extended to the communities using systematic and applied interventions specific to the communities and facilities be scaled as cost effective and efficient intervention for DRTB in high burden locations.