Challenges to Providing Patient-Centered Care for Multidrug-Resistant Tuberculosis (MDR-TB) in South Africa

2.50
Hdl Handle:
http://hdl.handle.net/10755/616259
Category:
Full-text
Type:
Presentation
Title:
Challenges to Providing Patient-Centered Care for Multidrug-Resistant Tuberculosis (MDR-TB) in South Africa
Other Titles:
Care of Patients Living With HIV/AIDS
Author(s):
Kelly, Ana Maria; Smith, Barbara Ann; Farley, Jason
Lead Author STTI Affiliation:
Non-member
Author Details:
Ana Maria Kelly, RN, ak3825@columbia.edu; Barbara Ann Smith, RN, FAAN; Jason Farley, RN, CRNP, FAAN
Abstract:
Session presented on Sunday, July 24, 2016: Purpose: The incidence of multidrug-resistant tuberculosis (MDR-TB) is on the rise globally.' MDR-TB takes a minimum of 2 years to treat and the treatment regimen produces many adverse drug reactions (ADRs).' The World Health Organization (WHO) has called for further research on the treatment of community-based MDR-TB patients as care is being decentralized to outpatient settings.' In the WHO?s TB progress report for 2015, they note there is a dearth of literature about anti-TB drug-induced mortality, morbidity and loss in quality of life, particularly in low-resource settings. 'This study directly addresses this gap in knowledge by examining the effect of ADRs from MDR-TB treatment on heath-related quality of life (HRQOL) for patients in a low-resource, high HIV-burden population in South Africa. ' Methods: A cross-sectional, observational study design was used to: 1) examine the effect of each ADR on HRQOL, controlling for patient and clinical characteristics; 2) describe concordance between patient report and clinician documentation ADRs. MDR-TB patients in the initial intensive phase of treatment were recruited using convenience sampling from an outpatient MDR-TB clinic in South Africa.' Patient interviews were conducted in English or isiZulu and included questions on individual characteristics (age, sex, education, employment, relationship status, alcohol/smoking, stigma, and adherence) and environmental characteristics (housing status, food insecurity, social support and discrimination).' ADRs and symptom bother over the past month of treatment were collected using a symptom checklist and HRQOL was collected using the EQ-5D.' A medical chart data abstraction was conducted to capture MDR-TB treatment, HIV/AIDS status and treatment, co-morbidities, BMI, laboratory values, and clinician documentation of ADRs. ' Results: The majority of participants (n=121) were co-infected with HIV (75%), female (51%), and did not have enough food to eat everyday (51%). Aim 1) All but two participants reported at least one ADR (98%) with an average of 8.6 per person. An increase in total ADRs was significantly related to a decrease in HRQOL.' Of the 18 ADRs assessed, six were associated with a decrease in HRQOL in the final multivariable model: tinnitus, gastrointestinal symptoms: nausea/vomiting and diarrhea, and symptoms affecting movement: myalgia, arthralgia, and peripheral neuropathy. Aim 2)'ADRs were reported much more frequently in the patient interviews (' = 8.6) compared to medical records (' = 1.4). Insomnia was most common (67 vs. 2%), followed by peripheral neuropathy (65 vs. 18%), and confusion (61 vs. 4%). Kappa scores were very low, with the highest degree of concordance found in hearing loss (kappa = 0.23), which was the only ADR not found to be significantly different between the two data sources (p = 0.34). Conclusion: This study helps fill the knowledge gap on the effect of ADRs from MDR-TB treatment on HRQOL. The study also'showed a lack of concordance between patient report and clinician documentation of ADRs. These findings indicate the need for improved documentation of ADRs to better reflect the patient experience during MDR-TB treatment. These data have important implications for country-level pharmacovigilance programs that rely on clinician documentation of ADRs for MDR-TB policy formation.'For clinicians, findings reinforce the need to improve detection, documentation and management of ADRs to provide patient-centered care.' Further research is needed to determine effective ADR management techniques to improve HRQOL outcomes for patients on this lengthy and challenging treatment.
Keywords:
Patient-centered; Tuberculosis; HIV
Repository Posting Date:
13-Jul-2016
Date of Publication:
13-Jul-2016 ; 13-Jul-2016
Other Identifiers:
INRC16J06; INRC16J06
Conference Date:
2016
Conference Name:
27th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Cape Town, South Africa
Description:
Theme: Leading Global Research: Advancing Practice, Advocacy, and Policy

Full metadata record

DC FieldValue Language
dc.language.isoenen
dc.type.categoryFull-texten
dc.typePresentationen
dc.titleChallenges to Providing Patient-Centered Care for Multidrug-Resistant Tuberculosis (MDR-TB) in South Africaen
dc.title.alternativeCare of Patients Living With HIV/AIDSen
dc.contributor.authorKelly, Ana Mariaen
dc.contributor.authorSmith, Barbara Annen
dc.contributor.authorFarley, Jasonen
dc.contributor.departmentNon-memberen
dc.author.detailsAna Maria Kelly, RN, ak3825@columbia.edu; Barbara Ann Smith, RN, FAAN; Jason Farley, RN, CRNP, FAANen
dc.identifier.urihttp://hdl.handle.net/10755/616259-
dc.description.abstractSession presented on Sunday, July 24, 2016: Purpose: The incidence of multidrug-resistant tuberculosis (MDR-TB) is on the rise globally.' MDR-TB takes a minimum of 2 years to treat and the treatment regimen produces many adverse drug reactions (ADRs).' The World Health Organization (WHO) has called for further research on the treatment of community-based MDR-TB patients as care is being decentralized to outpatient settings.' In the WHO?s TB progress report for 2015, they note there is a dearth of literature about anti-TB drug-induced mortality, morbidity and loss in quality of life, particularly in low-resource settings. 'This study directly addresses this gap in knowledge by examining the effect of ADRs from MDR-TB treatment on heath-related quality of life (HRQOL) for patients in a low-resource, high HIV-burden population in South Africa. ' Methods: A cross-sectional, observational study design was used to: 1) examine the effect of each ADR on HRQOL, controlling for patient and clinical characteristics; 2) describe concordance between patient report and clinician documentation ADRs. MDR-TB patients in the initial intensive phase of treatment were recruited using convenience sampling from an outpatient MDR-TB clinic in South Africa.' Patient interviews were conducted in English or isiZulu and included questions on individual characteristics (age, sex, education, employment, relationship status, alcohol/smoking, stigma, and adherence) and environmental characteristics (housing status, food insecurity, social support and discrimination).' ADRs and symptom bother over the past month of treatment were collected using a symptom checklist and HRQOL was collected using the EQ-5D.' A medical chart data abstraction was conducted to capture MDR-TB treatment, HIV/AIDS status and treatment, co-morbidities, BMI, laboratory values, and clinician documentation of ADRs. ' Results: The majority of participants (n=121) were co-infected with HIV (75%), female (51%), and did not have enough food to eat everyday (51%). Aim 1) All but two participants reported at least one ADR (98%) with an average of 8.6 per person. An increase in total ADRs was significantly related to a decrease in HRQOL.' Of the 18 ADRs assessed, six were associated with a decrease in HRQOL in the final multivariable model: tinnitus, gastrointestinal symptoms: nausea/vomiting and diarrhea, and symptoms affecting movement: myalgia, arthralgia, and peripheral neuropathy. Aim 2)'ADRs were reported much more frequently in the patient interviews (' = 8.6) compared to medical records (' = 1.4). Insomnia was most common (67 vs. 2%), followed by peripheral neuropathy (65 vs. 18%), and confusion (61 vs. 4%). Kappa scores were very low, with the highest degree of concordance found in hearing loss (kappa = 0.23), which was the only ADR not found to be significantly different between the two data sources (p = 0.34). Conclusion: This study helps fill the knowledge gap on the effect of ADRs from MDR-TB treatment on HRQOL. The study also'showed a lack of concordance between patient report and clinician documentation of ADRs. These findings indicate the need for improved documentation of ADRs to better reflect the patient experience during MDR-TB treatment. These data have important implications for country-level pharmacovigilance programs that rely on clinician documentation of ADRs for MDR-TB policy formation.'For clinicians, findings reinforce the need to improve detection, documentation and management of ADRs to provide patient-centered care.' Further research is needed to determine effective ADR management techniques to improve HRQOL outcomes for patients on this lengthy and challenging treatment.en
dc.subjectPatient-centereden
dc.subjectTuberculosisen
dc.subjectHIVen
dc.date.available2016-07-13T11:08:21Z-
dc.date.issued2016-07-13-
dc.date.issued2016-07-13en
dc.date.accessioned2016-07-13T11:08:21Z-
dc.conference.date2016en
dc.conference.name27th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationCape Town, South Africaen
dc.descriptionTheme: Leading Global Research: Advancing Practice, Advocacy, and Policyen
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.