PhD study Examines Different Models of Care for Patients with MDR-TB and HIV

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UKZN graduate Dr Marian Loveday carried out a doctoral Public Health study that investigated the effectiveness of two different models of care for patients with MDR-TB and HIV.

Loveday’s thesis, conducted under the supervision of Dr Anna Voce and Dr Nesri Padayatchi, was titled Decentralised Treatment of Multi-Drug Resistant Tuberculosis (MDR-TB) in KwaZulu-Natal: Evaluation of a Pilot Project.

Her study compared the effectiveness of different models of care for patients with MDR-TB and HIV.  The first was care in a centralised specialised hospital and she compared this with care in four decentralised sites scattered throughout KwaZulu-Natal. 

She also investigated what health system factors impacted on treatment outcomes.

Her findings showed that in routine Department of Health sites decentralised care was more effective than centralised care.  ‘But, I also showed that guidelines were rolled out very differently at the four different sites and the treatment outcomes varied across these sites,’ said Loveday. ‘The study indicated that the context (district and facility management) impacted on treatment outcomes. Supportive management resulted in more motivated staff who worked harder and achieved more successful treatment outcomes.’

Loveday says her research is novel in that it is the largest study ever undertaken (1549 patients) within routine health services.

Although the study was conducted in South Africa, her results were published internationally. Six peer-reviewed articles she completed for her PhD were published in international journals.

Loveday currently works at the South African Medical Research Council where she is involved in further MDR-TB studies. ‘There is such a lot of exciting work to be done in the area of MDR-TB.  There are so many unexplored and undocumented areas.’

She wants to help improve health services for MDR-TB patients.  ‘I am fascinated with health systems and analysing how the systems so often fail the patient and how we can address problems and improve the services.’ 

Loveday, who lives in Pietermaritzburg, said her three children were very proud of her achievement.

 Nombuso Dlamini