An analysis of adherence & equity in access to TB services in Mitchell's Plain, South Africa

Master Thesis


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University of Cape Town

The control of tuberculosis (TB) in South Africa has fallen short of the targets outlined by the World Health Organization and without improvement; TB is expected to have grave consequences for both the mortality and morbidity of South Africans as well as crippling financial consequences for the public health system. While services in the public sector are free at the point of use, little is known about overall access barriers and their implications for treatment adherence. This paper explores these barriers from the perspective of TB patients enrolled in Directly Observed Treatment, Short-Course (DOTS) in Mitchell's Plain, South Africa. Using a comprehensive framework of access, in-depth interviews were conducted with 334 TB patients across five facilities in Mitchell's Plain, to assess barriers across the dimensions of availability, affordability and acceptability. Summary statistics were computed and comparisons of access barriers between adherent and non-adherent groups, and between socioeconomic groups were explored using bivariate, multivariate linear and logistic regressions. Among the respondents, 244 (73.05%) met the criteria for adherence (i.e. reported that they had never missed a dose of TB medication) while 90 (26.95%) met the criteria for non-adherence. Marital status, age, birth province, costs of self-care and costs of other providers were found to be significantly associated with adherence (P-values <0.05). There was no significant evidence of inequalities in access by socioeconomic status (all P-values > 0.05). Nonetheless, the results revealed that the poor face increased costs of accessing TB-services, compared to the rich, though this association was not deemed to be significant.

Includes bibliographical references.