Model of care and risk factors for poor outcomes in patients on multi-drug resistant tuberculosis treatment at two facilities in eSwatini (formerly Swaziland), 2011-2013.

INTRODUCTION:Since 2011 Médecins sans Frontières together with the eSwatini Ministry of Health have been managing patients with multi-drug resistant tuberculosis (MDR-TB) at Matsapha and Mankayane in Manzini region. This analysis describes the model of care and outcomes of patients receiving a 20 months MDR-TB treatment regimen between 2011 and 2013. METHOD:We conducted a retrospective observational cohort study of MDR-TB patients enrolled for treatment between May 2011 and December 2013. An extensive package of psychological care and socio-economic incentives were provided including psychological support, paid treatment supporters, transport fees and a monthly food package. Baseline demographic details and treatment outcomes were recorded and for HIV positive patient's univariate analysis as well as a cox regression hazard model were undertaken to assess risk factors for unfavorable outcomes. RESULTS:From the 174 patients enrolled, 156 (89.7%) were HIV co-infected, 102 (58.6%) were female, median age 33 years old (IQR: 28-42), 55 (31.6%) had a BMI less than 18 and 86 (49.4%) had not been previously treated for any form of TB. Overall cohort outcomes revealed a 75.3% treatment success rate, 21.3% mortality rate, 0.6% failure and 0.6% lost to follow-up rate. In the adjusted multivariate analysis, low BMI and low CD4 count at treatment initiation were associated with an increased risk of unfavorable outcome. CONCLUSIONS:A model of care that included psychosocial support and patient's enablers led to a high level of treatment success with a very low lost to follow up rate. Limiting the overall treatment success was a high mortality rate which was associated with advanced HIV and a low BMI at presentation. These factors will need to be addressed in order to improve upon the overall treatment success rate in future

From Harare to Rio de Janeiro : Kukiya-Favela organization of the excluded

This article, based on ethnographic research conducted with people in Brazil and Zimbabwe, reports organization/management experiences and narratives of poor and marginalized people of the south. South embodies the organizational struggle, survival skills and resilience of marginal and urban outcasts that inhabit inner cities, townships and slums. The article employs the notion of kukiya-favela organization, i.e. the organization of the excluded, to engage with them in order to: give voice to those who dwell at the margins of organization studies; make their narratives part of a subject that retains an elitist position; and re-address the Eurocentric management/organization discourse that imposes a legitimate justification for exploiting, excluding and labelling them as organization-less and urban outcasts of society. The article concludes that despite their marginality and exclusion they are able to construct local diverse meaningful (organizational) identities that can represent them with dignity in their struggle for justice and basic human rights. Finally, it reflects on the contribution this has for us, in organization studies, by opening new spaces for the study of organization[al] (lives) not from positions of ‘above’ or ‘against’ but ‘with’ (Gergen, 2003: 454)