Abstract
IntroductionDrug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015. This study explored whether DR-TB training and mentoring supported healthcare workers’ (HCWs) DR-TB care performance.MethodsThis mixed study assessed HCWs’ DR-TB care knowledge, the training quality, and the mentoring around 454 HCWs who were trained across 55 DR-TB sites between January 2016 and December 2017. Pre- and post-training tests, end-of-training evaluation, supervisor’s interviews, DR-TB team self-assessment and team focus group discussion were conducted among trained HCWs. Interim and final treatment results of the national central site and the decentralized sites were compared.ResultsHCW’s knowledge increased for 15–20% between pre-training and post-training. HCWs and supervisors perceived mentoring as most appropriate to further develop their DR-TB competencies. Culture negativity after 6 months of treatment was similar for the decentralized sites compared to the national central site, 81% vs 79%, respectively, whereas decentralized sites had less loss to follow-up (0% versus 3%) and fewer deaths (3% versus 12%). Delays in laboratory results, stigma, and HCWs shortage were reported the main challenges of decentralized care.ConclusionsTraining and mentoring to provide DR-TB care at decentralized sites in Tanzania improved HCWs’ knowledge and skills in DR-TB care and supported observed good interim and final patient treatment outcomes despite health system challenges.
Highlights
Drug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015
The prevalence of multidrug resistant tuberculosis (MDR-TB) in Tanzania was estimated at 1.0% among new TB patients and 4.1% among retreatment patients in 2017 [1]
Quantitative results The number of DR-TB initiation sites increased from 1 national DR-TB site (KIDH) to 55 sites from January 2016 to December 2017
Summary
Drug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015. In 2009, Tanzania started Programmatic Management of Drug Resistant TB (PMDT) using a centralized approach whereby all patients were managed at one national site; the Kibong’oto Infectious Diseases Hospital (KIDH). In 2015, the National Tuberculosis and Leprosy Program (NTLP) developed the Implementation Framework for Expanded Decentralization of MDR-TB Services in Tanzania [4] as a step to decentralize DR-TB diagnosis and care. This adopted an approach intended to provide DR-TB treatment on an ambulatory basis utilizing community-based providers so as to reduce hospital admissions for DR-TB patients. To implement the decentralization of DR-TB services, NTLP designed a competency-based training and mentoring package for the facility HCWs
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