“Life continues”: Patient, health care and community care workers perspectives on self-administered treatment for rifampicin-resistant tuberculosis in Khayelitsha, South Africa

BackgroundSelf-administered treatment (SAT), a differentiated model of care for rifampicin-resistant tuberculosis (RR-TB), might address adherence challenges faced by patients and health care systems. This study explored patient, health-care worker (HCW) and community care worker (CCW) perspectives on a SAT pilot programme in South Africa, in which patients were given medication to take at home with the optional support of a CCW.MethodsWe conducted a mixed-methods study from July 2016-June 2017. The quantitative component included semi-structured questionnaires with patients, HCWs and CCWs; the qualitative component involved in-depth interviews with patients enrolled in the pilot programme. Interviews were conducted in isiXhosa, translated, transcribed and manually coded.ResultsOverall, 27 patients, 12 HCWs and 44 CCWs were enrolled in the quantitative component; nine patients were also interviewed. Of the 27 patients who completed semi-structured questionnaires, 22 were HIV-infected and 17 received a monthly supply of RR TB treatment. Most HCWs and CCWs (10 and 32, respectively) understood the pilot programme; approximately half (n = 14) of the patients could not correctly describe the pilot programme. Overall, 11 and 41 HCWs and CCWs reported that the pilot programme promoted treatment adherence. Additionally, 11 HCWs reported that the pilot programme relieved pressure on the clinic. Key qualitative findings highlighted the importance of a support person and how the flexibility of SAT enabled integration of treatment into their daily routines and reduced time spent in clinics. The pilot programme was also perceived to allow patients more autonomy and made it easier for them to manage side-effects.ConclusionThe SAT pilot programme was acceptable from the perspective of patients, HCWs and CCWs and should be considered as a differentiated model of care for RR-TB, particularly in settings with high burdens of HIV, in order to ease management of treatment for patients and health-care providers.背景：自我给药治疗（Self-administered treatment, SAT）作为利福平耐药结核病（rifampicin-resistant tuberculosis, RR-TB）的差异化照护模式，有望解决患者与医疗体系面临的治疗依从性难题。本研究针对南非的一项SAT试点项目，探究了患者、医护人员（health-care worker, HCW）以及社区护理人员（community care worker, CCW）对此项目的看法，该项目中患者可居家服药，并可选择获得社区护理人员的支持。 方法：本研究于2016年7月至2017年6月开展混合方法研究。定量研究部分采用半结构化问卷对患者、医护人员及社区护理人员进行调查；定性研究部分则对参与该试点项目的患者开展深度访谈。访谈以科萨语（isiXhosa）进行，随后完成翻译、转录与手动编码。 结果：定量研究共纳入27名患者、12名医护人员与44名社区护理人员；另有9名患者参与了定性访谈。在完成半结构化问卷的27名患者中，22名合并人类免疫缺陷病毒（HIV）感染，17名每月领取利福平耐药结核病治疗药物。多数医护人员（10名）与社区护理人员（32名）理解该试点项目的内容；约半数（n=14）患者无法准确描述该试点项目。总计有11名医护人员与41名社区护理人员表示，该试点项目提升了治疗依从性。另有11名医护人员指出，该项目缓解了诊所的工作压力。定性研究的核心结果凸显了陪护人员的重要性，以及自我给药治疗的灵活性如何帮助患者将治疗融入日常作息，减少了就诊耗时。此外，参与者认为该试点项目赋予患者更多自主权，并更便于患者应对治疗不良反应。 结论：从患者、医护人员与社区护理人员的视角来看，该SAT试点项目具备可接受性，其可作为利福平耐药结核病的差异化照护模式加以推广，尤其适用于HIV负担较高的地区，以减轻患者与医疗服务提供者的治疗管理负担。