Directly-observed treatment strategy implementation practices in a hospital in eThekwini health district

Abstract

Background: The incidence rate of tuberculosis (TB) in South Africa remains high, with the country ranked as having the 14th-highest incidence rate internationally; 646 per 100 000 people are infected with TB nationally, whilst KwaZulu-Natal has a provincial incidence of 1466 per 100 000. The Directly-Observed Treatment Strategy (DOTS) programme is intended to ensure both treatment completion and cure of TB, as well as its evaluation. Despite improved DOTS coverage – the focus of most DOTS studies – the incidence of drug-resistant TB suggests that issues of non-compliance are centrally responsible for ongoing concerns about the implementation and practices related to DOTS. Objectives: The aim of the study was to explore and describe DOTS implementation practices. The objectives of the study were to explore and describe the DOTS implementation practices of professional nurses and to describe modifiable barriers to DOTS. Method: A qualitative, descriptive, explorative study was conducted through individual interviews until saturation was reached. Results: The study revealed that DOTS implementation was not in accordance with World Health Organization prescripts. Participants reported barriers such as limited human and material resources, ineffective communication of policy and procedural guidelines, ineffective communication between service delivery institutions and lack of continuity of care, as well as a lack of recording and reporting. Conclusion: The study recommended a comprehensive recruitment process to facilitate greater training and employment of more permanent health professionals to combat TB in the community; and to re-launch the DOTS programme in underperforming facilities. This would give much needed momentum to efforts targeted at preventing treatment defaults amongst patients.