Patient-Pathway Analysis of Tuberculosis Services in Cameroon.

Collins N Titahong,Yvonne Waindim,Alison Wringe,Irene Adeline Goupeyou Wandji,Vincent Mbassa,Dubliss Nguafack,Melissa S Sander,Albert Kuate Kuate,Ellen M H Mitchell,Gideon N Ayongwa

doi:10.3390/tropicalmed6040171

Abstract

In Cameroon, in 2019, tuberculosis (TB) treatment coverage was estimated at 53%, indicating that almost half of all people sick with TB were not diagnosed or linked to care. To inform strategies to improve access to TB services, we conducted an evaluation of the alignment between patient-initiated care-seeking behavior and spatial and institutional allocation of TB services. Data sources included the Cameroon Demographic and Health Survey (2018), the Health Facility List (2017), and routinely collected TB surveillance data. Data visualization was performed in Tableau and QGIS. The pathway analysis showed that only an estimated 9% of people attended a health facility providing TB services at initial care-seeking, with access varying from <3% to 16% across the ten regions of the country. While 72% of government and 56% of private hospitals (Level 2 facilities) provide TB services, most Cameroonians (87%) initially chose primary care (Level 1) or informal private sector sites (Level 0) without TB services. The gaps were greatest in regions with the highest prevalence of poverty, a significant determinant for TB. These results indicate that access may be improved by expanding TB services at both public and private facilities across the country, prioritizing regions with the greatest gaps.

Highlights

In 2019, an estimated 2.9 million of the total 10 million people with tuberculosis (TB) were not diagnosed, notified, or linked to TB treatment [1]
To further explore the availability of services, we evaluated access by region, where initial care-seeking and access to TB testing and treatment are shown by the level of service (Level 0, 1, or 2) in Figure 2 and by type of service provider
The combined patient-pathway analysis indicated that 24% of people had access to diagnosis at initial care-seeking and 25% had access to TB treatment

Summary

Introduction

In 2019, an estimated 2.9 million of the total 10 million people with tuberculosis (TB) were not diagnosed, notified, or linked to TB treatment [1]. Finding and treating people with TB is challenging due to many factors, including non-specific disease presentation, inadequate performance of the currently available rapid diagnostic techniques, and the limited resources of many of the people and countries that are most affected by TB [2]. Access to TB diagnosis and treatment is a major barrier in many settings, and insufficient availability of diagnostic and treatment resources contributes to ongoing transmission and mortality [3]. Several complementary gap analysis tools have been described to assess the challenges people face in accessing care for TB, including the Onion Model [7], patient care cascades [8], the MATCH approach [9], and Finding all the Missing Persons [10] Another approach, the TB patient-pathway analysis (PPA), has been recommended by the Lancet

Methods

Results

Discussion

Conclusion