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1.
BMC Health Serv Res ; 22(1): 2, 2022 Jan 02.
Artículo en Inglés | MEDLINE | ID: mdl-34974843

RESUMEN

BACKGROUND: More than half of the TB patients in India seek care from the private sector. Two decades of attempts by the National TB Program to improve collaboration between the public and private sectors have not worked except in a few innovative pilots. The System for TB Elimination in Private Sector (STEPS) evolved in 2019 as a solution to ensure standards of TB care to every patient reaching the private sector. We formally evaluated the STEPS to judge the success of the model in achieving its outcomes and to inform decisions about scaling up of the model to other parts of the country. METHODS: An evaluation team was constituted involving all relevant stakeholders. A logic framework for the STEPS model was developed. The evaluation focused on (i) processes - whether the activities are taking place as intended and (ii) proximal outcomes - improvements in quality of care and strengthening of TB surveillance system. We (i) visited 30 randomly selected STEPS centres for assessing infrastructure and process using a checklist, (ii) validated the patient data with management information system of National TB Elimination Program (NTEP) by telephonic interview of 57 TB patients (iii) analysed the quality of patient care indicators over 3 years from the management information system (iv) conducted in-depth interviews (IDI) with 33 beneficiaries and stakeholders to understand their satisfaction and perceived benefits of STEPS and (v) performed cost analysis for the intervention from the perspective of NTEP, private hospital and patients. RESULTS: Evaluation revealed that STEPS is an acceptable model to all stakeholders. IDIs revealed that all patients were satisfied about the services received. Data in management information system of NTEP were consistent with the hospital records and with the information provided by the patient. Quality of TB care indicators for patients diagnosed in private hospitals showed improvements over years as proportion of TB patients notified from private sector with a microbiological confirmation of diagnosis improved from 25% in 2018 to 38% in 2020 and the documented treatment success rate increased from 33% (2018 cohort) to 88% (2019 cohort). Total additional programmatic cost (deducting cost for patient entitlements) per additional patient with successful treatment outcome was estimated to be 67 USD. Total additional expense/business loss for implementing STEPS for the hospital diagnosing 100 TB patients in a year was estimated to be 573 USD while additional minimum returns for the hospital was estimated to be 1145 USD. CONCLUSION: Evaluation confirmed that STEPS is a low cost and patient-centric strategy. STEPS successfully addressed the gaps in the quality of care for patients seeking care in the private sector and ensured that services are aligned with the standards of TB care. STEPS could be scaled up to similar settings.


Asunto(s)
Sector Privado , Tuberculosis , Hospitales Privados , Humanos , India/epidemiología , Atención Dirigida al Paciente , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/terapia
2.
Esc. Anna Nery Rev. Enferm ; 26: e20210109, 2022.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1346058

RESUMEN

Resumo Objetivo Analisar as percepções de enfermeiros sobre gestão do cuidado e seus fatores intervenientes para o controle da tuberculose na Atenção Primária em Saúde. Método Estudo descritivo, qualitativo, realizado com 29 enfermeiros que atuavam no controle da tuberculose em 23 Unidades Básicas de Saúde de Belém, Pará. Os dados foram produzidos por entrevistas individuais, utilizando roteiro semiestruturado, e submetidos à análise de conteúdo temática, proposta por Bardin. Resultados Originaram-se duas categorias temáticas: "A gestão do cuidado de enfermeiros para o controle da tuberculose nas Unidades Básicas de Saúde" e "Fatores intervenientes na efetivação da gestão do cuidado no controle da tuberculose nas Unidades Básicas de Saúde". Conclusão e implicações para a prática O conhecimento dos enfermeiros sobre a política e a gestão do cuidado no controle da tuberculose precisa ser fortalecido, e embora eles tenham clareza sobre suas competências, não conseguem realizá-las em sua plenitude por questões referentes à pouca organização dos serviços, centralização das atividades nos enfermeiros, baixa cooperação multiprofissional, falta de insumos e de pessoal e questões socioeconômicas ligadas ao usuário com tuberculose.


Resumen Objetivo Analizar la percepción de enfermeros sobre la gestión de la atención y los factores intervinientes para el control de la tuberculosis en la Atención Primaria de la Salud. Método Estudio descriptivo cualitativo realizado con 29 enfermeros que pre en el control de la tuberculosis en 23 Unidades Básicas de Salud de Belém, Pará. Los datos fueron producidos por entrevistas individuales, utilizando un guion semiestructurado, y sometido al análisis de contenido temático propuesto por Bardin. Resultados Se originaron dos categorías temáticas: "La gestión de la atención de enfermeros para el control de la tuberculosis en las Unidades Básicas de Salud" y "Factores intervinientes en la efectividad de la gestión de la atención en el control de la tuberculosis en las Unidades Básicas de Salud". Conclusión e implicaciones para la práctica Es necesario fortalecer el conocimiento de las enfermeras sobre la política y la gestión de la atención en el control de la tuberculosis, y aunque tienen claras sus competencias, no pueden implementarlas en su totalidad debido a problemas relacionados con la mala organización de los servicios, la centralización de actividades en los enfermeros, baja cooperación multiprofesional, falta de insumos y personal y aspectos socioeconómicos relacionados con el usuario con tuberculosis.


Abstract Objective To analyze nurses' perceptions on care management and its intervening factors for tuberculosis control in Primary Health Care. Method A descriptive and qualitative study conducted with 29 nurses who worked on tuberculosis control in 23 Basic Health Units in Belém, Pará. The data were produced by individual interviews, using a semi-structured script, and submitted to thematic content analysis, as proposed by Bardin. Results Two thematic categories emerged, namely: "Care management by nurses for tuberculosis control in Basic Health Units" and "Intervening factors in the application of care management for tuberculosis control in Basic Health Units". Conclusion and implications for the practice The nurses' knowledge about the care policy and management for tuberculosis control needs to be strengthened and, although nurses are aware of their competences, they are unable to fully implement them due to issues related to poor organization services, centralization of activities on them, low multiprofessional cooperation, scarcity of supplies and personnel, and socioeconomic issues related to tuberculosis patients.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Atención Primaria de Salud , Tuberculosis/prevención & control , Gestión en Salud , Enfermeras y Enfermeros/psicología , Práctica Profesional , Apoyo Social , Factores Socioeconómicos , Tuberculosis/enfermería , Tuberculosis/terapia , Educación en Salud , Investigación Cualitativa , Vulnerabilidad en Salud , Capacitación Profesional , Estigma Social , Cumplimiento y Adherencia al Tratamiento , Atención de Enfermería
3.
Recurso de Internet en Inglés | LIS - Localizador de Información en Salud | ID: lis-48542

RESUMEN

The eTB database of guidelines is a freely accessible tool that collects all WHO’s recommendations on TB prevention and care and categorizes them for efficient use. It is the result of a collaboration between the WHO Global TB department, the McMaster University GRADE centre and EvidencePrime, Inc. It allows decision-makers to search and find recommendations based on their questions of interest. The recommendation is then presented in detail along with its strength and the certainty of the evidence underlying it. Moreover, links to additional information that provide a transparent link between the recommendation and the judgments based on available evidence are available, such as the Evidence to Decision tables (EtD) and other evidence synthesis products. This database will be kept up to date and grow by adding prior and future WHO TB recommendations in real time.


Asunto(s)
Tuberculosis/prevención & control , Tuberculosis/terapia , Guías de Práctica Clínica como Asunto
4.
Pan Afr Med J ; 39: 279, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34754356

RESUMEN

Introduction: cross-border mobility of persons with Tuberculosis (TB) is a global public health concern. We aimed at documenting health systems´ potential bottlenecks and opportunities in pulmonary TB continuum of care in cross-border expanses of East and Horn of Africa. Methods: a cross-sectional program assessment with descriptive analysis of TB services, health staff capacities, diagnostic capacities, data management and reporting, and treatment outcomes. Data were extracted from health facility TB registers and semi-structured key informant interviews conducted in selected 26 cross-border sites within the 7 member states of the Intergovernmental Authority on Development (IGAD) region. Results: the overall cross-border TB cure rate in the year preceding the study (37%) was way beneath the global target with considerable variations amongst the study countries. The restricted support to the cross-border health facilities was mediated and even exacerbated by expansive distances from the respective capital cities. Restricted geographical access to the facilities by cross-border populations was a longstanding challenge. Substantial staffing gaps, TB service delivery capacity needs and inadequate diagnostics were noticeable. The TB control guidelines were not harmonized between the countries and the inter-country referral systems were either absent or inappreciable, contributing to ineffective cross-border referrals and transfers. The frail linkages between stakeholders were contemptible, but increasing governments´ commitments in tackling infectious diseases were encouraging. Conclusion: cross-border TB interventions should drive regional TB policies, strategies and programs that sustain countries´ coordination, harmonization of management guidelines, advocacy for increased human resources support, enhanced capacity building of cross-border TB staff, adequate diagnostics equipping of the cross-border health facilities and seamless transfer and referral of patients traversing boundaries.


Asunto(s)
Atención a la Salud/organización & administración , Emigración e Inmigración , Salud Pública , Tuberculosis/terapia , África , Creación de Capacidad , Continuidad de la Atención al Paciente/organización & administración , Estudios Transversales , Guías como Asunto , Política de Salud , Humanos , Internacionalidad , Tuberculosis/diagnóstico , Tuberculosis/prevención & control
6.
BMC Public Health ; 21(1): 1841, 2021 10 12.
Artículo en Inglés | MEDLINE | ID: mdl-34641849

RESUMEN

BACKGROUND: Tuberculosis (TB) presents a high burden of disease and is considered a global emergency by the World Health Organization (WHO), as the leading cause of death from infectious disease in adults. TB incidence is related directly to access to health services and socioeconomic determinants and inequality. Providing primary care settings can lead to improved access, shorter waiting times for patients, and enhanced TB case detection. The article aims to identify the spatial and temporal risk areas for TB and the relationship between TB cure and primary healthcare coverage from 2012 to 2014 in Rio de Janeiro, Brazil. METHODS: A cross-sectional study was conducted in Rio de Janeiro, Brazil. All cases of TB reported to the Information System on Diseases of Notification (SINAN) from 2012 to 2014 were included. Socioeconomic variables from the 2010 Brazilian national census were also added. Socioeconomic variables were selected from multivariate analysis using principal factors analysis. Spatial association was verified with generalized additive model (GAM). It was possible to identify areas at higher risk of failure to cure TB. RESULTS: TB rates showed strong positive spatial autocorrelation. TB cure rate varied according to schooling (individuals with complete secondary schooling had higher cure rates than illiterate individuals; OR 1.72, 95% CI 1.30-2.29), alcohol consumption (OR 0.47, 95% CI 0.35-0.64), contact investigation (OR 2.00, 95% CI 1.56-2.57), positive HIV serology (OR 0.31, 95% CI 0.23-0.42), and census tracts with higher elderly rates (OR 9.39, 95% CI 1.03-85.26). Individuals who had been covered by primary healthcare (PHC) for 35 to 41 months had 1.64 higher odds of cure, compared to those with no PHC coverage (95% CI 1.07-2.51). CONCLUSION: A comprehensive risk map was developed, allowing public health interventions. Spatial analysis allowed identifying areas with lower odds of TB cure in the city of Rio de Janeiro. TB cure was associated statistically with time of coverage by primary healthcare. TB cure rate also varied according to sociodemographic factors like schooling, alcohol abuse, and population density. This methodology can be generalized to other areas and/or other public health problems. HIGHLIGHTS: We studied standardized municipal TB cure rates in an area of social inequality in Brazil. TB rates showed strong positive spatial autocorrelation. Higher rates were associated with population density and socioeconomic conditions. Illiterate individuals were less likely to achieve TB cure. TB cure was less likely in individuals with HIV and alcohol abuse. TB cure was greater in areas with high primary healthcare coverage.


Asunto(s)
Tuberculosis , Adulto , Brasil/epidemiología , Estudios Transversales , Humanos , Atención Primaria de Salud , Factores Socioeconómicos , Análisis Espacial , Tuberculosis/epidemiología , Tuberculosis/terapia
7.
BMJ Open ; 11(10): e049900, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34598986

RESUMEN

OBJECTIVE: Psychosocial and economic (socioeconomic) barriers, including poverty, stigma and catastrophic costs, impede access to tuberculosis (TB) services in low-income countries. We aimed to characterise the socioeconomic barriers and facilitators of accessing TB services in Nepal to inform the design of a locally appropriate socioeconomic support intervention for TB-affected households. DESIGN: From August 2018 to July 2019, we conducted an exploratory qualitative study consisting of semistructured focus group discussions (FGDs) with purposively selected multisectoral stakeholders. The data were managed in NVivo V.12, coded by consensus and analysed thematically. SETTING: The study was conducted in four districts, Makwanpur, Chitwan, Dhanusha and Mahottari, which have a high prevalence of poverty and TB. PARTICIPANTS: Seven FGDs were conducted with 54 in-country stakeholders, grouped by stakeholders, including people with TB (n=21), community stakeholders (n=13) and multidisciplinary TB healthcare professionals (n=20) from the National TB Programme. RESULTS: The perceived socioeconomic barriers to accessing TB services were: inadequate TB knowledge and advocacy; high food and transportation costs; income loss and stigma. The perceived facilitators to accessing TB care and services were: enhanced championing and awareness-raising about TB and TB services; social protection including health insurance; cash, vouchers and/or nutritional allowance to cover food and travel costs; and psychosocial support and counselling integrated with existing adherence counselling from the National TB Programme. CONCLUSION: These results suggest that support interventions that integrate TB education, psychosocial counselling and expand on existing cash transfer schemes would be locally appropriate and could address the socioeconomic barriers to accessing and engaging with TB services faced by TB-affected households in Nepal. The findings have been used to inform the design of a socioeconomic support intervention for TB-affected households. The acceptability, feasibility and impact of this intervention on TB-related costs, stigma and TB treatment outcomes, is now being evaluated in a pilot implementation study in Nepal.


Asunto(s)
Tuberculosis , Humanos , Renta , Nepal , Pobreza , Investigación Cualitativa , Tuberculosis/terapia
8.
Artículo en Inglés | MEDLINE | ID: mdl-34639403

RESUMEN

BACKGROUND: Women in the rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for the disease of tuberculosis (TB). This study was conducted to assess the general understanding of TB and for women's access to healthcare, as a first step towards implementation of a gender responsive TB program in Tando Allahyar, a rural district of Pakistan. METHODS: A total of 36 participants were interviewed for the study. The focus group discussion guide comprised of questions on: (1) family/household dynamics, (2) community norms, (3) healthcare systems, (4) women's access to healthcare, (5) TB Awareness, and (6) women's access to TB Care. RESULTS: Limited autonomy in household financial decision-making, disapproval of unassisted travel, long travel time, lack of prioritization of spending on women's health and inadequate presence of female health providers, were identified as barriers to access healthcare for women, which is even higher in younger women. Facilitators to access of TB care included a reported lack of TB-related stigma, moderate knowledge about TB disease, and broad understanding of tuberculosis as a curable disease. Other suggested facilitators include health facilities closer to the villages and the availability of higher quality services. CONCLUSION: Significant barriers are faced by women in accessing TB care in rural districts of Pakistan. Program implementers in high burden countries should shift towards improved gender-responsive TB programming.


Asunto(s)
Accesibilidad a los Servicios de Salud , Tuberculosis , Femenino , Humanos , Pakistán/epidemiología , Investigación Cualitativa , Población Rural , Tuberculosis/epidemiología , Tuberculosis/terapia
9.
Zhonghua Er Ke Za Zhi ; 59(11): 963-967, 2021 Nov 02.
Artículo en Chino | MEDLINE | ID: mdl-34711032

RESUMEN

Objective: To explore the clinical utility of bronchoscopy and transbronchial cryotherapy in children with tracheobronchial tuberculosis (TBTB). Methods: Retrospective study was conducted to collect the clinical data of 10 hospitalized children who underwent bronchoscopy and were diagnosed as TBTB and in the Department of Pediatrics of Peking University First Hospital and the Department of Pediatric Respiratory Medicine of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2011 to October 2019. The clinical characteristics of TBTB in children, and the efficacy and safety of bronchoscopy and transbronchial cryotherapy were summarized through descriptive analysis. Results: The onset age of 10 children (6 males and 4 females) ranged from 1-14 years. The clinical manifestations included fever (8/10), cough (7/10) and hemoptysis (2/10). Purified protein derivative test and interferon-γ release assay were performed in 9 and 10 patients respectively, the results were all positive. Chest CT examination was performed in all patients, and 8 patients had hilar and mediastinal lymphadenopathy. All patients underwent pediatric bronchoscopy in time, in 9 patients bronchus was found to be blocked in varying degrees by granulation tissue and caseous necrosis and in the remaining patient, obvious congestion and edema in bronchial mucosa. The bronchoscopic manifestations included 8 cases of lymph node fistula type, 1 case of granulation proliferative type and 1 case of inflammatory infiltration type. Pathological biopsies were performed in 7 cases, the findings were consistent with the pathological characteristics of tuberculosis. Nine patients were treated by pediatric bronchoscopic intervention, with 8 transbronchial cryotherapy by flexible bronchoscopy, and among them, 2 patients were treated by simultaneous rigid bronchoscopy. After 1-3 times of transbronchial cryotherapy, the blocked bronchial lumina in 8 cases were all recanalized, and the curative effect was significant without any serious complications. Conclusions: Bronchoscopy plays an important role in the diagnosis of TBTB in children and is helpful for its classification. Also, transbronchial cryotherapy has good efficacy and safety for TBTB in children, especially for the granuloproliferative type or lymph node fistula type.


Asunto(s)
Tuberculosis , Adolescente , Bronquios , Broncoscopía , Niño , Preescolar , Crioterapia , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Tuberculosis/diagnóstico , Tuberculosis/terapia
10.
BMC Public Health ; 21(1): 1928, 2021 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-34688266

RESUMEN

BACKGROUND: Tuberculosis (TB) care can be costly for patients and their families. The End TB Strategy includes a target that zero TB affected households should experience catastrophic costs associated with TB care. Costs are catastrophic when a patient spends 20% or more of their annual household income on their TB diagnosis and care. In Solomon Islands the costs of TB care are unknown. The aim of this study was to determine the costs of TB diagnosis and care, the types of costs and the proportion of patients with catastrophic costs. METHODS: This was a nationally representative cross-sectional survey of TB patients carried out between 2017 and 2019. Patients were recruited from health care facilities, from all ten provinces in Solomon Islands. During an interview they were asked about the costs of TB diagnosis and care. These data were analysed using descriptive statistics to describe the costs overall and the proportions of different types of costs. The proportion of patients with catastrophic costs was calculated and a multivariate logistic regression was undertaken to determine factors associated with catastrophic costs. RESULTS: One hundred and eighty-three TB patients participated in the survey. They spent a mean of 716 USD (inter quartile range: 348-1217 USD) on their TB diagnosis and care. Overall, 62.1% of costs were attributable to non-medical costs, while income loss and medical costs comprised 28.5 and 9.4%, respectively. Overall, 19.7% (n = 36) of patients used savings, borrowed money, or sold assets as a financial coping mechanism. Three patients (1.6%) had health insurance. A total of 92.3% (95% CI: 88.5-96.2) experienced catastrophic costs, using the output approach. Being in the first, second or third poorest wealth quintile was significantly associated with catastrophic costs (adjusted odds ratio: 67.3, 95% CI: 15.86-489.74%, p <  0.001). CONCLUSION: The costs of TB care are catastrophic for almost all patients in Solomon Islands. The provision of TB specific social and financial protection measures from the National TB and Leprosy Programme may be needed in the short term to ameliorate these costs. In the longer term, advancement of universal health coverage and other social and financial protection measures should be pursued.


Asunto(s)
Costos de la Atención en Salud , Tuberculosis , Análisis Costo-Beneficio , Estudios Transversales , Humanos , Renta , Tuberculosis/diagnóstico , Tuberculosis/terapia
11.
BMJ Open ; 11(9): e051291, 2021 09 21.
Artículo en Inglés | MEDLINE | ID: mdl-34548361

RESUMEN

OBJECTIVES: This study was aimed to assess the willingness of elderly people to seek medical care for tuberculosis (TB) and the associated influencing factors. DESIGN: A cross-sectional study. SETTING: A multistage random survey was conducted in Bao'an District of Shenzhen in China. PARTICIPANTS: A total of 1200 elderly people aged 65 or above were recruited for the study and completed a structured questionnaire between September and October 2019. MAIN OUTCOME MEASURES: Descriptive and binary logistic stepwise regression analyses were conducted to analyse the characteristics of elderly individuals, their willingness to seek medical care for TB and associated factors. RESULTS: Among the final 1123 respondents, 943 (84.0%) were willing to seek medical care if they discovered suspicious TB symptoms. Binary logistic stepwise regression analysis indicated that respondents whose family annual income per capita was 50 000-100 000¥ (OR=2.56, 95% CI: 1.44 to 4.54, p<0.01) and who had positive attitudes (≥3 scores: OR=3.10, 95% CI: 1.90 to 5.05, p<0.01) or practices (≥4 scores: OR=3.13, 95% CI: 1.82 to 5.39, p<0.01) towards TB were more willing to seek medical care for TB. CONCLUSIONS: Willingness to seek medical care for TB in the elderly population can be improved according to the determinants.


Asunto(s)
Tuberculosis , Anciano , China/epidemiología , Estudios Transversales , Humanos , Atención al Paciente , Encuestas y Cuestionarios , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/terapia
12.
BMJ Glob Health ; 6(9)2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34526321

RESUMEN

BACKGROUND: Community health worker (CHW) programmes are a valuable component of primary care in resource-poor settings. The evidence supporting their effectiveness generally shows improvements in disease-specific outcomes relative to the absence of a CHW programme. In this study, we evaluated expanding an existing HIV and tuberculosis (TB) disease-specific CHW programme into a polyvalent, household-based model that subsequently included non-communicable diseases (NCDs), malnutrition and TB screening, as well as family planning and antenatal care (ANC). METHODS: We conducted a stepped-wedge cluster randomised controlled trial in Neno District, Malawi. Six clusters of approximately 20 000 residents were formed from the catchment areas of 11 healthcare facilities. The intervention roll-out was staggered every 3 months over 18 months, with CHWs receiving a 5-day foundational training for their new tasks and assigned 20-40 households for monthly (or more frequent) visits. FINDINGS: The intervention resulted in a decrease of approximately 20% in the rate of patients defaulting from chronic NCD care each month (-0.8 percentage points (pp) (95% credible interval: -2.5 to 0.5)) while maintaining the already low default rates for HIV patients (0.0 pp, 95% CI: -0.6 to 0.5). First trimester ANC attendance increased by approximately 30% (6.5pp (-0.3, 15.8)) and paediatric malnutrition case finding declined by 10% (-0.6 per 1000 (95% CI -2.5 to 0.8)). There were no changes in TB programme outcomes, potentially due to data challenges. INTERPRETATION: CHW programmes can be successfully expanded to more comprehensively address health needs in a population, although programmes should be carefully tailored to CHW and health system capacity.


Asunto(s)
Infecciones por VIH , Desnutrición , Enfermedades no Transmisibles , Tuberculosis , Niño , Agentes Comunitarios de Salud , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Humanos , Malaui/epidemiología , Desnutrición/diagnóstico , Desnutrición/epidemiología , Desnutrición/prevención & control , Salud Materna , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Embarazo , Tuberculosis/epidemiología , Tuberculosis/terapia
13.
Infect Dis Poverty ; 10(1): 120, 2021 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-34544492

RESUMEN

BACKGROUND: Tuberculosis (TB) is a major global health threat and the leading infectious disease cause of death worldwide. Access to and retention in TB care remains a challenge for patients, particularly those living in rural and remote settings. This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze (Shigatse) prefecture, Xizang Autonomous Region (Tibet Autonomous Region), China from the perspective of persons impacted by TB. METHODS: We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture, Xizang Autonomous Region, China between April 2019 and November 2020. Interviews were conducted in Tibetan and Mandarin, transcribed in Mandarin and translated into English. Transcripts were checked against recordings by native Tibetan and Mandarin speakers. QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al. RESULTS: Overall patients reported low awareness of and an indifferent attitude towards TB, although all reported understanding the need to adhere to treatment. Participants reported complex pathways to care, often requiring visits to multiple healthcare facilities. Some participants reported visiting traditional Tibetan medicine (TTM) providers. Participants reported various barriers to accessing care including challenges physically reaching care, out-of-pocket payments for tests, diagnostics and transport. Barriers to maintaining care included medication side effects and worry about treatment effectiveness. Enablers to accessing care identified included knowledge or past experience with TB, integrated models of TTM and western care, supportive village doctors who conducted home visits, free TB treatment and other subsidies, as well as having family support with care and social support as barriers and facilitators to maintaining treatment. CONCLUSIONS: We identified barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB. Challenges include complex pathways to care, travel distances, wait times and low awareness. Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness, partnerships with TTM providers, providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care.


Asunto(s)
Accesibilidad a los Servicios de Salud , Tuberculosis , Adolescente , Adulto , Niño , Preescolar , China , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Tuberculosis/terapia , Adulto Joven
15.
PLoS One ; 16(9): e0256795, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34473752

RESUMEN

Achieving targets set in the End TB Strategy is still a distant goal for many Low- and Middle-Income Countries (LMICs). The importance of strengthening public-private partnership by engaging all identified providers in Tuberculosis (TB) care has long been advocated in global TB policies and strategies. However, Informal Healthcare Providers (IPs) are not yet prioritised and engaged in National Tuberculosis Programs (NTPs) globally. There exists a substantial body of evidence that confirms an important contribution of IPs in TB care. A systematic understanding of their role is necessary to ascertain their potential in improving TB care in LMICs. The purpose of this review is to scope the role of IPs in TB care. The scoping review was guided by a framework developed by the Joanna Briggs Institute. An electronic search of literature was conducted in MEDLINE, EMBASE, SCOPUS, Global Health, CINAHL, and Web of Science. Of a total 5234 records identified and retrieved, 92 full-text articles were screened, of which 13 were included in the final review. An increasing trend was observed in publication over time, with most published between 2010-2019. In 60% of the articles, NTPs were mentioned as a collaborator in the study. For detection and diagnosis, IPs were primarily involved in identifying and referring patients. Administering DOT (Directly Observed Treatment) to the patient was the major task assigned to IPs for treatment and support. There is a paucity of evidence on prevention, as only one study involved IPs to perform this role. Traditional health providers were the most commonly featured, but there was not much variation in the role by provider type. All studies reported a positive role of IPs in improving TB care outcomes. This review demonstrates that IPs can be successfully engaged in various roles in TB care with appropriate support and training. Their contribution can support countries to achieve their national and global targets if prioritized in National TB Programs.


Asunto(s)
Atención a la Salud/métodos , Países en Desarrollo , Personal de Salud , Renta , Mycobacterium tuberculosis , Tuberculosis/diagnóstico , Tuberculosis/terapia , Salud Global , Humanos , Evaluación de Resultado en la Atención de Salud , Pobreza , Tuberculosis/microbiología
16.
Pan Afr Med J ; 39: 167, 2021.
Artículo en Francés | MEDLINE | ID: mdl-34539963

RESUMEN

Multifocal tuberculosis is rare in immunocompetent subjects. It is characterized by the involvement of at least two extra-pulmonary sites, associated or not with lung disease. It is often difficult to diagnose. We here report a case of multifocal tuberculosis in a non-immunocompromised black African subject at the Hubert Koutoukou Maga National Hospital and University Center (CNHU-HKM) in Cotonou, Benin. The study involved a 23-year-old man, with no particular previous history, admitted with diffuse abdominal pain associated with alteration of general state. Clinical examination showed severe malnutrition and medium-volume ascites. Imaging tests (chest X-ray, ultrasound and computed tomography (CT) scan) showed multiple lung, liver, pancreatic, bone, lymph nodes and colic lesions suggesting multimetastatic tumor. Colonoscopy then showed budding lesion of the cecum. GeneXpert test showed Koch´s bacilli. The anatomo-pathological examination of colic biopsies and GeneXpert sputum test confirmed multifocal tuberculosis. The patient received antituberculosis treatment and nutritional support. However he died. Multifocal tuberculosis is a serious disease that is difficult to diagnose. Then it is frequently mis-diagnosed in tropical areas, especially when it occurs in immunocompetent patients.


Asunto(s)
Antituberculosos/administración & dosificación , Neoplasias del Colon/diagnóstico , Tuberculosis/diagnóstico , Dolor Abdominal/etiología , Benin , Neoplasias del Colon/patología , Colonoscopía , Resultado Fatal , Humanos , Inmunocompetencia , Masculino , Desnutrición/diagnóstico , Apoyo Nutricional/métodos , Tomografía Computarizada por Rayos X , Tuberculosis/terapia , Adulto Joven
17.
PLoS One ; 16(8): e0252095, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34464392

RESUMEN

BACKGROUND: Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. METHODS: We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method). RESULTS: Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6-8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0-5.0)-an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status. CONCLUSIONS: Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients' preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.


Asunto(s)
Atención a la Salud , Infecciones por VIH , VIH-1 , Aceptación de la Atención de Salud , Tiempo de Tratamiento , Tuberculosis , Adulto , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis/terapia , Zambia/epidemiología
18.
Afr Health Sci ; 21(1): 248-253, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34394304

RESUMEN

Background: Tuberculosis and Human Immunodeficiency Virus epidemics in sub-Saharan Africa have been closely related and persistent, proving a considerable burden for healthcare provision. This has complicated utilization of services, with noted opinions on the integration of these services from both users and providers of the services. Objectives: To establish the users and the provider's perspectives in overcoming the challenges of TB/HIV services integration at Mulago National Referral Hospital. Methods: Descriptive cross-sectional design, with predominantly qualitative methods was used. Qualitative aspect adopted phenomenological design. Participants were randomly selected for FGDs and Key informants. An observation checklist collected quantitative data from the patients to measure level of services integration. Findings: Level of service integration of TB/HIV services was at 68% (below the acceptable 100% level). Opinions from the users pointed to; increasing number of work-days for TB/HIV service provision, strengthening sensitisation and health education and integrating other services like reproductive health services, among others. Health care providers opinions pointed to increasing trainings for health workers, increasing staffing and need for more support from Ministry of Health. Conclusion: Opinions from both users and providers were similar. These ranged from increasing awareness to the users and healthcare providers about the integration of services.


Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Infecciones por VIH/terapia , Personal de Salud/psicología , Aceptación de la Atención de Salud/psicología , Tuberculosis/terapia , Adolescente , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Investigación Cualitativa , Derivación y Consulta , Servicios de Salud Reproductiva , Uganda , Adulto Joven
19.
Pan Afr Med J ; 39: 27, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34394818

RESUMEN

Introduction: patient delay in seeking TB (tuberculosis) care is reported as one of the major hurdles undermining the efforts of controlling TB by many TB control programmes of the world. The main aim of this study was to determine the prevalence of this phenomenon and to profile the TB patients that delayed seeking TB care in a rural area of KwaZulu Natal province of South Africa. Methods: this was a cross-sectional study, conducted among 200 TB patients attending primary health care facilities in Ugu District. Patient data were collected by a self-administered questionnaire, entered into an Excel file and imported into the EpiInfo 7 statistical software for analysis. Frequency tables were used to display the data and the p value was used for statistical significance. Results: about 40% of the participants delayed seeking TB care in this study, and these were mostly individuals who were married, the employed and those who walked to the clinic. Delay was also prevalent among those that self-medicated, bought medication from the pharmacy and sought TB care from a private doctor. The reasons included the great distances, long queues waiting at the facilities, and not feeling ill. Conclusion: the 4 weeks cut-off in seeking TB care in this study far exceeds the recommended 2 weeks. This study recommends periodic active TB case finding and active engagement between the public and the private health sectors.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Tuberculosis/terapia , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Sudáfrica , Encuestas y Cuestionarios , Adulto Joven
20.
Lancet Infect Dis ; 21(9): e272-e280, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34450080

RESUMEN

Meeting the 2035 WHO targets of reducing tuberculosis incidence by 90% from 2015 levels requires the implementation of country-specific tuberculosis control strategies. This systematic review aims to identify factors that facilitate or impede the implementation of such strategies in EU and European Economic Area (EEA) settings. Focusing on providers of care, health system constraints, and social and political factors, this Review complements available evidence on the accessibility of tuberculosis services to recipients of care. Databases were searched for EU and EEA articles published between Jan 1, 1997, and Nov 6, 2020, that presented empirical data on tuberculosis policies, strategies, guidelines, or interventions. 2061 articles were screened and 65 were included. The most common barrier to tuberculosis control strategies described the divergence of health-care practices from guidelines, often related to inadequate knowledge or perceived usefulness of the guidelines by clinicians. The most commonly identified enabler to tuberculosis control strategies was the documented positive attitudes of health-care workers towards tuberculosis programmes. Divergence between clinical practice and guidelines was described in most EU and EEA settings, indicating the need for a focused review of guideline adherence. Strengths of this study involve its broad inclusion criteria and wide range of tuberculosis control strategies analysed.


Asunto(s)
Control de Infecciones , Tuberculosis/epidemiología , Tuberculosis/terapia , Bases de Datos Factuales , Europa (Continente)/epidemiología , Personal de Salud , Humanos , Incidencia
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