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

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Infectious Diseases of Poverty 2021年第3期10卷 82-94页

作者： Jamie Murdoch Robyn Curran andre jvan rensburg Ajibola Awotiwon Audry Dube Max Bachmann Inge Petersen Lara Fairall School of Health Sciences University of East AngliaNorwich NR47TJUK. University of Cape Town Lung Institute Knowledge Translation UnitUniversity of Cape TownMowbray 7700South Africa Centre for Rural Health University of KwaZulu NatalDurbanSouth Africa Norwich Medical School University of East AngliaNorwich NR47TJUK. King's Global Health Institute King's College LondonLondon SE19NHUK. Knowledge Translation Unit Department of MedicineUniversity of Cape Town Lung InstituteUniversity of Cape TownMowbray 7700South Africa.

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

关键词： Tuberculosis Health systems strengthening Primary healthcare Person-centred care Context

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