Community-Based Managment of Multidrug Resistant Tuberculosis in Rural Kwazulu-Natal

Multidrug Resistant Tuberculosis (MDR-TB) is a significant health burden in South Africa, and it is particularly problematic in the region of KwaZulu-Natal. MDR-TB is not susceptible to most first-line medications, and antibacterial treatment for resistant bacteria may take up to 24 months to complete. The majority of this treatment process occurs outside the confines of the MDR-TB ward – in the community. This project examines the provision of community-based care to MDR-TB patients in a rural area of Northern KwaZulu-Natal, and attempts to understand the multifaceted system of MDR-TB control. Community-based care is one of the essential steps in the treatment of MDR-TB due to the lengthy treatment process and the potential for adverse side effects. Without a comprehensive system of community-based care, MDRTB has the opportunity to proliferate and to amplify its resistance. This project explores the roles, motivations, and skills of various community caregivers who are responsible for treating and overseeing MDR-TB patients in the community, such as the TB tracers, injection nurses, home assessors, and community health workers who all play integral roles in managing MDR-TB. Participant observation and informal conversations with these hospital personnel allowed for a comprehensive understanding of the management of MDR-TB in the community, and to assess the obstacles to care posed by a rural environment. This experience led to the conclusion that a comprehensive, community-based strategy is necessary for the containment of MDR-TB and that significant funding should be allocated for strengthening MDR-TB control systems. so c ia l s c ie n c e 13 this necessitates the provision of injections directly to the home [8]. Those who test positive for MDR-TB are hospitalized in the MDR-TB ward and immediately started on injection therapy with either amikacin (AMK) or kanamycin (KM). This injection is administered to the patient six days a week for approximately two months in the hospital ward. Each month, patients must provide a sputum sample to test for the presence of bacilli. Typically the patient’s sputum (mucus from the lower airways) will convert to negative after a period of two months on injections (Nurse 1, Personal Communication, November 8, 2011). According to Department of Health policy, “patients who have negative sputum microscopy and who are clinically not too ill may be initiated on MDR-TB treatment as outpatients if access to daily injections can