Health care worker's perspective on the MDR-TB treatment guidelines in South Africa

BackgroundTreatment guidelines are developed and updated according to evidence-based research. Healthcare workers in the public health sector are responsible for the implementation of said guidelines. The multi-drug resistant tuberculosis (MDR-TB) guideline has undergone major changes over the past 5 years. These changes included shorter treatment regimens and the introduction of novel drugs. These changes have consequently impacted the management of MDR-TB patients. ObjectivesTo establish healthcare workers perspectives on the MDR-TB guidelines and managing patients with MDR-TB. MethodsHealthcare workers employed in MDR-TB departments at Murchison District Hospital in KwaZulu-Natal were invited to complete a written questionnaire. These healthcare workers comprised of doctors, nurses, pharmacists, and data capturers. The questionnaire consisted of both open- and closed-ended questions. Descriptive statistics were generated for closed-ended questions using SPSS (version 25). Open-ended questions were transcribed onto Microsoft Excel and analyzed for common and emerging themes. ResultsThere were 44 staff employed in the inpatient and outpatient MDR-TB unit. Thirty-four of participants agreed to participate in the questionnaire. HIV co-infection was highlighted as a contributor to complicating the management of MDR-TB patients. The most common co-morbidities associated with MDR-TB patients were diabetes, anaemia and hypertension. The socioeconomic influence on outcomes were highlighted throughout patient responses. ConclusionThe MDR-TB program has come been progressive in its approach to gaining control over MDR-TB. The SBR is an effective regimen with a few safety concerns. The nature of ADRs associated with the regimen are serious with myelosuppression highlighted as a common ADR. The impact of socio-economic factors on treatment outcomes is an important factor that should be considered in addition to MDR-TB regimens. The BPaL regimen may offer benefits of a shorter duration and reduced pill burden but there are concerns over the safety of the regimen. The success of the MDR-TB program requires a holistic approach combining patient factors with an effective, safe and convenient regimen.