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Background: Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO). Methods: We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO. Findings: The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO. Interpretation: Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care. [ABSTRACT FROM AUTHOR]

Setting: Multidrug-resistant tuberculosis (MDR-TB) unit in KwaZulu-Natal, South Africa. Objective: To develop and evaluate a nurse case management model and intervention using the tenets of the Chronic Care Model to manage treatment for MDR-TB patients with a high prevalence of human immunodeficiency virus (HIV) co-infection. Design: A quasi-experimental pilot programme utilizing a nurse case manager to manage care for 40 hospitalized MDR-TB patients, 70% HIV co-infected, during the intensive phase of MDR-TB treatment. Patients were followed for six months to compare proximal outcomes identified in the model between the pre- and post-intervention period. Results: The greatest percent differences between baseline and six-month MDR-TB proximal outcomes were seen in the following three areas: baseline symptom evaluation on treatment initiation (95% improvement), baseline and monthly laboratory evaluations completed per guidelines (75% improvement), and adverse drug reactions acted upon by medical and/or nursing intervention (75% improvement). Conclusion: Improvements were identified in guideline-based treatment and monitoring of adverse drug reactions following implementation of the nurse case management intervention. Further study is required to determine if the intervention introduced in this model will ultimately result in improvements in final MDR-TB treatment outcomes. [ABSTRACT FROM AUTHOR]

Staff nurse and infection preventionist (IP) workload increases in response to exposures and outbreaks. The additional time required to manage these situations may differ by pathogen and role in patient care. Understanding the time burden associated with responding to specific pathogens may improve resource allocation. The purpose of this study was to evaluate workload increases reported by nurses and IPs in response to common exposures and outbreaks. Anonymous, voluntary surveys were distributed to nurses from eight units in a New York hospital network and IPs who attended the 2018 Association for Professionals in Infection Control and Epidemiology (APIC) annual conference or are members of New York/New Jersey APIC chapters. Respondents were asked to (1) rate daily workload increase as <30, 30-60, or >60 minutes in response to five exposure (lice/scabies, mumps/measles, pertussis, tuberculosis, influenza) and outbreak scenarios (methicillin-resistant Staphylococcus aureus, other multidrug-resistant organisms, non-influenza respiratory viruses, Clostridium difficile, gastrointestinal viruses), and (2) rank most time consuming activities during exposure/outbreak responses. One hundred fifty nurses and 228 IPs responded. Among nurses, >60 minute workload increases were most commonly reported for C. difficile (76%), lice/scabies (46%), and influenza (45%). Among IPs, >60 minute increases were most commonly reported for mumps/measles (66%), tuberculosis (64%), and C. difficile (50%). Among nurses, isolation precautions, patient/family education, and staffing changes were the most frequently reported time consuming activities. Among IPs, these were chart review, exposure list compiling, and preventive measures for exposures. Organisms that are easier to treat and more difficult to spread such as scabies/lice can contribute substantially to nursing workload. Despite requiring less care at the bedside, pathogens with airborne transmission are most time consuming for IPs. Notably, three quarters of nurses and half of IPs reported that C. difficile adds >1 hour to their daily workload. [ABSTRACT FROM AUTHOR]