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Abstract
In 2011, South Africa implemented a policy to decentralize treatment for rifampin-resistant tuberculosis (TB) to reduce durations of hospitalization and enable local treatment. We assessed policy implementation in Western Cape Province, where services expanded from 6 specialized TB hospitals to 406 facilities, by analyzing National Health Laboratory Service data on TB during 2012–2015. We calculated the percentage of patients who visited a TB hospital 1 year after rifampin-resistant TB diagnosis, the median duration of their hospitalizations, and the total distance between facilities visited. We assessed temporal changes with linear regression and stratified results by location. Of 2,878 patients, 65% were from Cape Town. In Cape Town, 29% visited a TB hospital; elsewhere, 68% visited a TB hospital. We found that hospitalizations and travel distances were shorter in Cape Town than in the surrounding areas. ....

Cape Town , Western Cape , South Africa , United States , Eastern Cape , South African , Mtbdrplus Hain Lifescience Gmb , African National Department Of Health , Environmental Systems Research Institute Inc , National Health Laboratory Service , Stellenbosch University Health Research Ethics Committee , Boston University Institutional Review Board , Boston University , South African National Department , Green Point , Stellenbosch University , Health Research Ethics Committee , Institutional Review Board , Hain Lifescience Gmbh , Western Cape Province , Environmental Systems Research Institute , Appendix Table , Median Euclidean , Although Western Cape , Antimicrobial Resistance , Decentralized Care ,