Gridlock from diagnosis to treatment of multidrug-resistant tuberculosis in Tanzania: low accessibility of molecular diagnostic services and lack of healthcare worker empowerment in 28 districts of 5 high burden TB regions with mixed methods evaluation (original) (raw)
Related papers
East African Health Research Journal
Characterise multidrug-resistant tuberculosis (MDR-TB)-treated cases during the scaling up of molecular diagnostics using Xpert MTB/RIF and GenoType MTBDRplus Design: Retrospective cohort study Results: A total of 223 MDR-TB patients were referred to the Kibong'oto Infectious Disease Hospital from January 2013 through December 2014. Four cities-Dar es Salaam, Mbeya, Mwanza, and Tanga-contributed 144 (65%) of referrals. Of the total referred patients, HIV coinfection was found in 92 (41%) and 180 (81%) had history of previous TB treatment. Molecular drug susceptibility testing (DST) contributed 201 (91%) of referrals and resulted in a shorter time from diagnosis to start of treatment, 30 days (95% confidence interval [CI], 26-37), compared to conventional phenotypic DST, 212 days (95% CI, 151-272; P<.001). Molecular DST found higher proportions of MDR-TB children and people living with HIV without prior treatment, 5 (12%) and 24 (56%), respectively, compared to those with previous treatment for TB, 4 (2%) and 68 (38%), respectively. The median CD4 count correspondingly was 131 cells/ll (IQR, 109-131) and 200 cells/ll (IQR, 94-337) for MDR-TB diagnosed by phenotypic and molecular diagnostics (P=.70). Despite the more rapid time to treatment initiation among patients diagnosed by molecular DST, treatment outcomes, including time to sputum culture conversion, did not differ compared to those diagnosed with conventional phenotypic DST. Regardless of the method of diagnosis, MDR-TB/HIV coinfected patients who died had lower CD4 counts (mean 86 6 87 cells/ll) than survivors (mean 274 6 224 cells/ll; P=.02). Conclusion: Molecular diagnostics appear to speedup the time to treatment initiation, but may not improve other treatment outcomes.
IntroductionMolecular diagnostics have revolutionized the diagnosis of multidrug resistant tuberculosis (MDR-TB). Yet in Tanzania we found delay in diagnosis with more than 70% of MDR-TB patients having history of several previous treatment courses for TB signaling complications of prior missed diagnosis. We aimed to explore patients’ viewpoints and experiences with personal and socio-behavioral obstacles from MDR-TB diagnosis to treatment in an attempt to understand these prior findings.MethodsThe study was conducted in December 2016 with MDR-TB patients admitted at Kibong’oto Infectious Diseases Hospital. We used semi-structured interviews and focus group discussion to examine patients’ views and experiences during MDR-TB diagnosis. Groups were sex aggregated to allow free interaction and to gauge gender specific issues in the social and behavioral contexts. The discussion – explored patients’ delivery factors that were impacting delay from MDR-TB diagnosis to treatment. Iterative...
2020
Background: Tuberculosis (TB), a treatable disease claims over a million lives every year. Accurate rapid diagnosis is crucial for early treatment initiation and prevention of severe disease. Despite over 10 years approval of molecular diagnostics for routine use, an estimated 3 million TB cases go undetected per year. We investigated the barriers and opportunities to maximise uptake and utilization of molecular diagnostics in routine healthcare settings. Methods: We deployed surveys, healthcare facility audits, focus group discussions, in-depth interviews, and policymaker dialogues to unravel factors affecting the uptake and utilization of TB molecular diagnostics in three East African countries. The benchmark was the World Health Organization approved Xpert MTB/RIF and Line Probe Assay (LPA) implemetation at district and regional hospital level respectively. Results: 190 district and county health officers participated in the survey. The survey findings were corroborated by 145 he...
BMC health services research, 2015
BackgroundStudies of the quality of tuberculosis (TB) diagnostic evaluation of patients in high burden countries have generally shown poor adherence to international or national guidelines. Health worker perspectives on barriers to improving TB diagnostic evaluation are critical for developing clinic-level interventions to improve guideline implementation.MethodsWe conducted structured, in-depth interviews with staff at six district-level health centers in Uganda to elicit their perceptions regarding barriers to TB evaluation. Interviews were transcribed, coded with a standardized framework, and analyzed to identify emergent themes. We used thematic analysis to develop a logic model depicting health system and contextual barriers to recommended TB evaluation practices. To identify possible clinic-level interventions to improve TB evaluation, we categorized findings into predisposing, enabling, and reinforcing factors as described by the PRECEDE model, focusing on potentially modifia...
Enhancing Tuberculosis Case-Finding: A Case of Quality Improvement Initiative in Tanzania
Tropical Medicine and Infectious Disease
Background: Tanzania is 1 of the 30 high TB burden countries and 1 of the 13 countries in which 75% of people with TB are unaccounted for and that is prioritized for the Global Fund Catalytic investment and Strategic Initiative support. Tanzania decided to strengthen its National TB Programme to find these people with TB who are unaccounted for by identifying evidence-driven innovations to deliver high-quality services and to improve the efficiency of TB case-finding. A quality improvement (QI) initiative was implemented by the National Tuberculosis and Leprosy Programme to enhance TB case-finding. The initiative involved identifying gaps in the quality of services, introducing new tools, improving the work capacity of health care workers through training and mentorship sessions, strengthening laboratory and referral services, and implementing mandatory TB screening of all patients attending health facilities. We aimed to assess the effectiveness of QI initiative to enhance TB case-...
The International Journal of Tuberculosis and Lung Disease, 2015
Setting-Drug susceptibility testing (DST) is recommended in Kenya to identify multidrugresistant tuberculosis (MDR-TB) in persons registered for retreatment of tuberculosis (TB). DST is performed at a central laboratory with a two-step growth-based process and a regional laboratory with a simultaneous molecular-and growth-based process. Objective-To compare proportions of retreatment cases that underwent DST and turnaround times for hospitals referring to the central versus regional laboratory. Design-Cases were persons registered for retreatment of TB during January 1, 2012 to December 31, 2013. Records were reviewed at 11 hospitals and 7 hospitals referring to the regional and central laboratories, respectively. Results-Overall, 238/432 (55%) and 88/355 (25%) of cases at hospitals referring to the regional and central laboratories, respectively, underwent DST. The mean time from case registration to receipt of DST results and initiation of MDR-TB treatment was faster for hospitals referring to the regional laboratory. Specimen transport, specimen testing, and receipt of DST results at hospitals were shorter for the regional laboratory (p < 0.05).