Identifying contextual determinants of problems in tuberculosis care provision in South Africa: a theory-generating case study

作     者：Jamie Murdoch Robyn Curran Andre Jvan Rensburg Ajibola Awotiwon Audry Dube Max Bachmann Inge Petersen Lara Fairall Murdoch Jamie;Curran Robyn;van Rensburg André J.;Awotiwon Ajibola;Dube Audry;Bachmann Max;Petersen Inge;Fairall Lara

作者机构：School of Health SciencesUniversity of East AngliaNorwich NR47TJUK. University of Cape Town Lung InstituteKnowledge Translation UnitUniversity of Cape TownMowbray 7700South Africa Centre for Rural HealthUniversity of KwaZulu NatalDurbanSouth Africa Norwich Medical SchoolUniversity of East AngliaNorwich NR47TJUK. King's Global Health InstituteKing's College LondonLondon SE19NHUK. Knowledge Translation UnitDepartment of MedicineUniversity of Cape Town Lung InstituteUniversity of Cape TownMowbray 7700South Africa. 

出 版 物：《Infectious Diseases of Poverty》 (贫困所致传染病（英文）)

年 卷 期：2021年第10卷第3期

页      面：82-94页

核心收录：

学科分类：1011[医学-护理学（可授医学、理学学位）] 10[医学] 

基　　金：funded by the National Institute for Health Research(NIHR)Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa King's College London(GHRU 16/136/54)using UK aid from the UK Government to support global health research.The views expressed in this publication are those of the author(s)and not necessarily those of the NIHR or the Department of Health and Social Care 

主　　题：Tuberculosis Health systems strengthening Primary healthcare Person-centred care Context 

摘      要：Background:Despite progress towards End TB Strategy targets for reducing tuberculosis(TB)incidence and deaths by 2035,South Africa remains among the top ten high-burden tuberculosis countries globally.A large challenge lies in how policies to improve detection,diagnosis and treatment completion interact with social and structural drivers *** understanding and theoretical development of the contextual determinants of problems inTB care is required for developing effective *** article reports findings from the pre-implementation phase of a study ofTB care in South Africa,contributing to HeAlth System StrEngThening in Sub-Saharan Africa(ASSET)-a five-year research programme developing and evaluating health system strengthening interventions in sub-Saharan *** study aimed to develop hypothetical propositions regarding contextual determinants of problems inTB care to inform intervention development to reduce TB deaths and incidence whilst ensuring the delivery of quality integrated,person-centred ***:Theory-building case study design using the Context and Implementation of Complex Interventions(CICI)framework to identify contextual determinants of problems in TB *** February and November 2019,we used mixed methods in six public-sector primary healthcare facilities and one public-sector hospital serving impoverished urban and rural communities in the Amajuba District of KwaZulu-Natal Province,South *** data included stakeholder interviews,observations and documentary *** data included routine data on sputum testing andTB *** were inductively analysed and mapped onto the seven CICI contextual ***:Delayed diagnosis was caused by interactions between fragmented healthcare provision;limited resources;verticalised care;poorTB screening,sputum collection and *** nurse responsible forTB care,with limited integration ofTB with other conditions,and policy focused o