Abstract:
In response to the drug-resistant tuberculosis (DRTB) ototoxicity burden in South Africa,
ototoxicity monitoring has been decentralised, with community health workers (CHWs) acting as
facilitators. This study describes a community-based ototoxicity monitoring programme (OMP)
for patients with DRTB. Findings are compared to the recommended guidelines for ototoxicity
monitoring, the OMP protocol and published studies. This was a retrospective study of longitudinal
ototoxicity monitoring of 831 patients with DRTB, using data collected at community-based clinics in
the City of Cape Town between 2013 and 2017. Approximately half (46.8%) of the patients had an
initial assessment conducted in accordance with the OMP protocol recommendations, and follow-up
rates (79.5%) were higher than those of a similar DRTB programme. However, patients in this study
were not monitored within the timeframes or with the regularity recommended by the guidelines
or the OMP protocol. Extended high-frequency pure-tone audiometry (27.5%) was underutilised
by testers and data recording was inconsistent (e.g., 37.7% of patient gender was not recorded
by testers). Community-based OMP using CHWs to facilitate monitoring showed improvement
over previous hospital-based reports, with more accessible services and higher follow-up rates.
However, to improve OMP outcomes, OMP managers should reassess current protocols and data
recording practices.
