Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa

Jason E Farley, Norbert Ndjeka, Ana M Kelly, Erin Whitehouse, Simmi Lachman, Chakra Budhathoki, Kelly Lowensen, Ellie Bergren, Hloniphile Mabuza, Ntombasekhaya Mlandu, Martie van der Walt, Jason E Farley, Norbert Ndjeka, Ana M Kelly, Erin Whitehouse, Simmi Lachman, Chakra Budhathoki, Kelly Lowensen, Ellie Bergren, Hloniphile Mabuza, Ntombasekhaya Mlandu, Martie van der Walt

Abstract

Background: Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO).

Methods: We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO.

Findings: The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO.

Interpretation: Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Participant enrollment and MDR-TB treatment…
Fig 1. Participant enrollment and MDR-TB treatment outcomes between CNP and MO.

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Source: PubMed

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