Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa

Int J Tuberc Lung Dis. 2015 Feb;19(2):163-71. doi: 10.5588/ijtld.14.0369.


Setting: KwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection.

Objective: To determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital.

Design: A non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation.

Results: Four community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites.

Conclusion: Community-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antitubercular Agents / therapeutic use*
  • Cohort Studies
  • Community Health Services / organization & administration*
  • Female
  • HIV Infections / complications
  • HIV Infections / drug therapy
  • Health Services Accessibility
  • Home Care Services / organization & administration
  • Hospitalization*
  • Humans
  • Male
  • Models, Theoretical
  • Prospective Studies
  • South Africa
  • Treatment Outcome
  • Tuberculosis, Multidrug-Resistant / drug therapy*


  • Anti-HIV Agents
  • Antitubercular Agents