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      Effects and determinants of tuberculosis drug stockouts in South Africa

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          Abstract

          Background

          The frequent occurrence of medicine stockouts represents a significant obstacle to tuberculosis control in South Africa. Stockouts can lead to treatment alterations or interruptions, which can impact treatment outcomes. This study investigates the determinants and effects of TB drug stockouts and whether poorer districts are disproportionately affected.

          Methods

          TB stockout data, health system indicators and TB treatment outcomes at the district level were extracted from the District Health Barometer for the years 2011, 2012 and 2013. Poverty terciles were constructed using the Census 2011 data to investigate whether stockouts and poor treatment outcomes were more prevalent in more impoverished districts. Fixed-effects regressions were used to estimate the effects of TB stockouts on TB treatment outcomes.

          Results

          TB stockouts occurred in all provinces but varied across provinces and years. Regression analysis showed a significant association between district per capita income and stockouts: a 10% rise in income was associated with an 8.50% decline in stockout proportions. In terms of consequences, after controlling for unobserved time invariant heterogeneity between districts, a 10% rise in TB drug stockouts was found to lower the cure rate by 2.10% ( p < 0.01) and the success rate by 1.42% ( p < 0.01). These effects were found to be larger in poorer districts.

          Conclusions

          The unequal spread of TB drug stockouts adds to the socioeconomic inequality in TB outcomes. Not only are stockouts more prevalent in poorer parts of South Africa, they also have a more severe impact on TB treatment outcomes in poorer districts. This suggests that efforts to cut back TB drug stockouts would not only improve TB treatment outcomes on average, they are also likely to improve equity because a disproportionate share of this burden is currently borne by the poorer districts.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-019-3972-x) contains supplementary material, which is available to authorized users.

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          HIV infection and multidrug-resistant tuberculosis: the perfect storm.

          Karin Weyer, Alyssa Finlay, T Holtz … (2007)
          Multidrug-resistant (MDR) tuberculosis (TB) has emerged as a global epidemic, with ~425,000 new cases estimated to occur annually. The global human immunodeficiency virus (HIV) infection epidemic has caused explosive increases in TB incidence and may be contributing to increases in MDR-TB prevalence. We reviewed published studies and available surveillance data evaluating links between HIV infection and MDR-TB to quantify convergence of these 2 epidemics, evaluate the consequences, and determine essential steps to address these epidemics. Institutional outbreaks of MDR-TB have primarily affected HIV-infected persons. Delayed diagnosis, inadequate initial treatment, and prolonged infectiousness led to extraordinary attack rates and case-fatality rates among HIV-infected persons. Whether this sequence occurs in communities is less clear. MDR-TB appears not to cause infection or disease more readily than drug-susceptible TB in HIV-infected persons. HIV infection may lead to malabsorption of anti-TB drugs and acquired rifamycin resistance. HIV-infected patients with MDR-TB have unacceptably high mortality; both antiretroviral and antimycobacterial treatment are necessary. Simultaneous treatment requires 6-10 different drugs. In HIV-prevalent countries, TB programs struggle with increased caseloads, which increase the risk of acquired MDR-TB. Surveillance data suggest that HIV infection and MDR-TB may converge in several countries. Institutional outbreaks, overwhelmed public health programs, and complex clinical management issues may contribute to the convergence of the MDR-TB and HIV infection epidemics. To forestall disastrous consequences, infection control, rapid case detection, effective treatment, and expanded program capacity are needed urgently.
          Article 0 comments Cited 127 times – based on 0 reviews     Review now
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            Health Product Supply Chains in Developing Countries: Diagnosis of the Root Causes of Underperformance and an Agenda for Reform

            Prashant Yadav (2015)
            Article 0 comments Cited 71 times – based on 0 reviews     Review now
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              Describing and decomposing post-apartheid income inequality in South Africa

              Murray Leibbrandt, Arden Finn, Ingrid Woolard (2012)
              Article 0 comments Cited 40 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                L. E. M. Koomen: +31 652214267 , Lisanne.koomen@gmail.com
                R. Burger: rburger@sun.ac.za
                E. K. A. van Doorslaer: vandoorslaer@ese.eur.nl
                Journal
                Journal ID (nlm-ta): BMC Health Serv Res
                Journal ID (iso-abbrev): BMC Health Serv Res
                Title: BMC Health Services Research
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6963
                Publication date (Electronic): 3 April 2019
                Publication date PMC-release: 3 April 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 213
                Affiliations
                [1 ]ISNI 0000000092621349, GRID grid.6906.9, Erasmus School of Health Policy and Management, , Erasmus University Rotterdam, ; Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
                [2 ]ISNI 0000 0001 2214 904X, GRID grid.11956.3a, Department of Economics, , Stellenbosch University, ; Stellenbosch, South Africa
                [3 ]ISNI 0000000092621349, GRID grid.6906.9, Erasmus School of Economics, , Erasmus University Rotterdam, ; Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
                Article
                Publisher ID: 3972
                DOI: 10.1186/s12913-019-3972-x
                PMC ID: 6448237
                PubMed ID: 30943967
                SO-VID: e7f8a1a0-1242-46c3-adaa-7ecab951852f
                Copyright statement: © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 June 2018
                Date accepted : 25 February 2019
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Health & Social care
                Keywords: drug stockouts,tuberculosis,treatment outcomes,equity
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: drug stockouts, tuberculosis, treatment outcomes, equity

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