ABSTRACT
Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013-2015, the RR-TB/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.
Subject(s)
Coinfection/drug therapy , Delivery of Health Care/organization & administration , HIV Infections/drug therapy , Health Plan Implementation , Leprosy/drug therapy , Tuberculosis, Multidrug-Resistant/drug therapy , Adolescent , Adult , Aftercare/organization & administration , Aftercare/statistics & numerical data , Anti-Retroviral Agents/therapeutic use , Antitubercular Agents/pharmacology , Antitubercular Agents/therapeutic use , Chemoprevention/methods , Cohort Studies , Coinfection/microbiology , Delivery of Health Care/methods , Delivery of Health Care/statistics & numerical data , Drug Resistance, Multiple, Bacterial , Female , HIV Infections/virology , Humans , Leprosy/microbiology , Male , Middle Aged , Models, Organizational , Mycobacterium leprae/isolation & purification , Mycobacterium tuberculosis/isolation & purification , Patient Care Team/organization & administration , Patient Care Team/statistics & numerical data , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use , Tuberculosis, Multidrug-Resistant/microbiology , Uganda , Young AdultABSTRACT
OBJECTIVE: To identify factors of professionals that relate to the degree of primary health care orientation in the control of leprosy. METHOD: Study carried out in 70 units of Family Health Strategy of a capital of Brazil, between July and September 2014. An evaluation instrument applied to 408 health professionals was used. The multiple linear regression-bootstrap model was applied to analyze the association of the general, essential and derived score with the explanatory factors of the professionals (work time in the unit and in primary care services, control actions, case care and leprosy training). RESULTS: In the descriptive analysis most of the professionals did not attend cases and did not receive training to perform leprosy actions. A strong orientation was observed in the essential and general score of primary care and the association with leprosy education. In the derived score, weak orientation and association were observed with training in the disease for doctors and community health agents. CONCLUSION: Professional experience in the Family Health Strategy and leprosy care is crucial for the service to be a provider of control actions oriented according to the essential and derived attributes of primary health care. Brazil has made progress in reducing the incidence of leprosy; however, it is necessary to increase the effectiveness of health surveillance, as a means of early detection and training of professionals.
Subject(s)
Community Health Workers/education , Education, Medical , Education, Nursing , Leprosy/therapy , Patient Care Team/organization & administration , Primary Health Care , Brazil , Community Health Workers/statistics & numerical data , Cross-Sectional Studies , Humans , Nurses/statistics & numerical data , Patient Care Team/statistics & numerical data , Physicians/statistics & numerical data , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Quality of Health Care , Regression AnalysisABSTRACT
Objective: The study's target has been to analyze the causes and solutions strategies for leprosy in children using the Ishikawa Diagram. Methods: It is a literature review based on the Ishikawa Diagram production, which was carried out over April 2017 in the databases of PubMed, Virtual Health Library (VHL), EBSCO and SciELO. Results: It was identified that the prevalence of leprosy in children is due to social, environmental and cultural factors, where: socioeconomic conditions, population cluster and lack of professional qualification correspond to 70% of the mentioned causes. Conclusion: It was evidenced the need for intensifying epidemiological surveillance, promoting larger investments in preventive actions, such as health education, including the adoption of professional training towards the professionals directly responsible the disease diagnosis
Objetivo: Analisar por meio do Diagrama de Ishikawa as causas e as estratégias de soluções para hanseníase em crianças. Método: Revisão da literatura baseada na construção do Diagrama de Ishikawa, realizado em abril de 2017, nos bancos de dados do Pubmed, Biblioteca Virtual de Saúde (BVS), Scielo e Ebsco. Resultados: Identificou-se que a prevalência da hanseníase em crianças se dá por fatores sociais, ambientais e culturais, onde: condições socioeconômicas, aglomerado populacional e ausência de capacitação profissional correspondem a 70% das causas apontadas. Conclusão: Evidenciou-se a necessidade de intensificar a vigilância epidemiológica, realizar maiores investimentos nas ações preventivas, como a educação em saúde, incluindo também a adoção de capacitações dos profissionais responsáveis pelo diagnóstico
Objetivo: Analizar por medio del diagrama de Ishikawa las causas y estrategias de las soluciones para la lepra en los niños. Método: Revisión de la literatura basada en la construcción del Diagrama de Ishikawa, realizado en abril de 2017 en los bancos de datos del Pubmed, Biblioteca Virtual de Salud (BVS), Scielo y Ebsco. Resultados: Se identificó que la prevalencia de la hanseniasis en niños se da por factores sociales, ambientales y culturales, donde: condiciones socioeconómicas, aglomerado poblacional y ausencia de capacitación profesional corresponden al 70% de las causas señaladas. Conclusión: Se evidenció la necesidad de intensificar la vigilancia epidemiológica, realizar mayores inversiones en las acciones preventivas, como la educación en salud, incluyendo también la adopción de capacitaciones de los profesionales responsables del diagnóstico