Linkage to care among adults being investigated for tuberculosis in South Africa: pilot study of a case manager intervention

Noriah Maraba; Violet Chihota; Kerrigan McCarthy; Gavin J Churchyard; Alison D Grant

doi:10.1136/bmjopen-2017-021111

Linkage to care among adults being investigated for tuberculosis in South Africa: pilot study of a case manager intervention

BMJ Open. 2018 May 24;8(5):e021111. doi: 10.1136/bmjopen-2017-021111.

Authors

Noriah Maraba^{1

2}, Violet Chihota^{1

2

3}, Kerrigan McCarthy^{2

4}, Gavin J Churchyard^{1

2

5

6}, Alison D Grant^{2

7

8}

Affiliations

¹ The Aurum Institute, Johannesburg, Gauteng, South Africa.
² School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
³ Foundation for Innovative New Diagnostics, Geneva, Switzerland.
⁴ National Institute for Communicable Diseases, Sandringham, South Africa.
⁵ Advancing Treatment and Care for TB and HIV, South African Medical Research Council Collaborating Centre for HIV/TB, Cape Town, South Africa.
⁶ London School of Hygiene and Tropical Medicine, London, UK.
⁷ TB Centre, London School of Hygiene & Tropical Medicine, London, UK.
⁸ School of Nursing and Public Health, Africa Health Research Institute, University of Kwazulu-Natal, Durban, South Africa.

Abstract

Objectives: We piloted an intervention to determine if support from a case manager would assist adults being investigated for tuberculosis (TB) to link into TB and HIV care.

Design: Pilot interventional cohort study.

Participants and setting: Patients identified by primary healthcare clinic staff in South Africa as needing TB investigations were enrolled.

Intervention: Participants were supported for 3 months by case managers who facilitated the care pathway by promoting HIV testing, getting laboratory results, calling patients to return for results and facilitating treatment initiation.

Outcomes measured: Linkage to TB care was defined as starting TB treatment within 28 days in those with a positive test result; linkage to HIV care, for HIV-positive people, was defined as having blood taken for CD4 count and, for those eligible, starting antiretroviral therapy within 3 months. Intervention implementation was measured by number of attempts to contact participants.

Results: Among 562 participants (307 (54.6%) female, median age: 36 years (IQR 29-44)), most 477 (84.8%) had previously tested for HIV; of these, 328/475 (69.1%) self-reported being HIV-positive. Overall, 189/562 (33.6%) participants needed linkage to care (132 HIV care linkage only; 35 TB treatment linkage only; 22 both). Of 555 attempts to contact these 189 participants, 407 were to facilitate HIV care linkage, 78 for TB treatment linkage and 70 for both. At the end of 3-month follow-up, 40 participants had not linked to care (29 of the 132 (22.0%) participants needing linkage to HIV care only, 4 of the 35 (11.4%) needing to start on TB treatment only and 7 of the 22 (31.8%) needing both).

Conclusion: Many people testing for TB need linkage to care. Despite case manager support, non-linkage into HIV care remained higher than desirable, suggesting a need to modify this intervention before implementation. Innovative strategies to enable linkage to care are needed.

Keywords: public health; tuberculosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Ambulatory Care Facilities
Anti-HIV Agents / therapeutic use
CD4 Lymphocyte Count
Case Managers*
Cohort Studies
Continuity of Patient Care*
Female
HIV Infections / complications
HIV Infections / diagnosis
HIV Infections / therapy*
Health Services Accessibility*
Hematologic Tests
Humans
Male
Mass Screening
Pilot Projects
Primary Health Care*
South Africa
Tuberculosis / complications
Tuberculosis / diagnosis
Tuberculosis / therapy*

Substances

Anti-HIV Agents