Effect of decentralising childhood tuberculosis diagnosis to primary health centre versus district hospital levels on disease detection in children from six high tuberculosis incidence countries: an operational research, pre-post intervention study.

Background: Childhood tuberculosis (TB) remains underdiagnosed largely because of limited awareness and poor access to all or any of specimen collection, molecular testing, clinical evaluation, and chest radiography at low levels of care. Decentralising childhood TB diagnostics to district hospitals (DH) and primary health centres (PHC) could improve case detection. Methods: We conducted an operational research study using a pre-post intervention cross-sectional study design in 12 DHs and 47 PHCs of 12 districts across Cambodia, Cameroon, Côte d'Ivoire, Mozambique, Sierra Leone and Uganda. The intervention included 1) a comprehensive diagnosis package at patient-level with tuberculosis screening for all sick children and young adolescents <15 years, and clinical evaluation, Xpert Ultra-testing on respiratory and stool samples, and chest radiography for children with presumptive TB, and 2) two decentralisation approaches (PHC-focused or DH-focused) to which districts were randomly allocated at country level. We collected aggregated and individual data. We compared the proportion of tuberculosis detection in children and young adolescents <15 years pre-intervention (01 August 2018-30 November 2019) versus during intervention (07 March 2020-30 September 2021), overall and by decentralisation approach. This study is registered with ClinicalTrials.gov, NCT04038632. Findings: TB was diagnosed in 217/255,512 (0.08%) children and young adolescent <15 years attending care pre-intervention versus 411/179,581 (0.23%) during intervention, (OR: 3.59 [95% CI 1.99-6.46], p-value<0.0001; p-value = 0.055 after correcting for over-dispersion). In DH-focused districts, TB diagnosis was 80/122,570 (0.07%) versus 302/86,186 (0.35%) (OR: 4.07 [1.86-8.90]; p-value = 0.0005; p-value = 0.12 after correcting for over-dispersion); and 137/132,942 (0.10%) versus 109/93,395 (0.11%) in PHC-focused districts, respectively (OR: 2.92 [1.25-6.81; p-value = 0.013; p-value = 0.26 after correcting for over-dispersion). Interpretation: Decentralising and strengthening childhood TB diagnosis at lower levels of care increases tuberculosis case detection but the difference was not statistically significant. Funding source: Unitaid, Grant number 2017-15-UBx-TB-SPEED.

Обзорная оценка Национальной программы по туберкулезу в Республике Молдова: 4–15 февраля 2013 года

Республика Молдова входит в число 18 приоритетных стран для борьбы с туберкулезом (ТБ) в Европейском регионе ВОЗ и 27 стран мира с высоким бременем ТБ с множественной лекарственной устойчивостью (МЛУ-ТБ). Согласно классификации Глобального фонда для борьбы со СПИДом, туберкулезом и малярией, Республика Молдова занимает второе место среди 110 стран по уровню средств, выделяемых на душу населения. Вторая фаза реализации консолидированного гранта в рамках раундов 8 и 9 была одобрена в декабре 2012 года с условием представления на следующем этапе обзорной оценки Национальной программы по туберкулезу и стратегического плана (на основе этой обзорной оценки) по усилению приверженности лечению и снижению числа пациентов, результаты лечения которых неизвестны. Серьезную озабоченность вызывал тот факт, что, как показала оценка, осуществление мер вмешательства и поддержка оказали лишь ограниченное воздействие на улучшение результатов лечения. В октябре 2012 года Министерство здравоохранения обратилось в Европейское региональное бюро ВОЗ с просьбой обеспечить координацию обзорной оценки Национальной программы по туберкулезу.

Review of the National Tuberculosis Programme in the Republic of Moldova: 4–15 February 2013

The Republic of Moldova is among the WHO European Region’s 18 high-priority countries for tuberculosis (TB) control and among the world’s 27 high multidrug-resistant TB (MDR-TB) burden countries. The Global Fund to Fight AIDS, Tuberculosis and Malaria ranks the Republic of Moldova second among 110 countries by level of funds provided per capita. The second phase of implementation of its consolidated Round 8 and 9 TB grant was approved in December 2012 with a request to submit, at a later stage, a review of the National TB Programme and a strategic plan (based on the review) to improve treatment compliance and reduce loss to treatment follow up. A major concern highlighted was that supported interventions have shown only a limited impact in improving treatment success. In October 2012 the Ministry of Health asked the WHO Regional Office for Europe to coordinate the review of the National TB Programme.The review took place from 4 to 15 February 2013. Twelve international and seven national experts participated, visiting 18 districts and three municipalities, the autonomous region of Gagauzia and the Transnistria region. The review team developed a strategic plan to improve treatment compliance and reduce loss to treatment follow up immediately after the review; this appears as part of the roadmap attached to this report (Annex 1). The team members conveyed their key findings and recommendations at the end of the mission to the Minister of Health.

Los servicios de laboratorio en el control de la tuberculosis / Los servicios de laboratorio en el control de la tuberculosis / Laboratory services in tuberculosis control

Contenido: pt.1. Organizacion y gestion. -- pt.2. Microscopia. -- pt.3. Cultivo