The Burden of Drug-Resistant Tuberculosis among Kenya's Devolved Health Units and Associated Treatment Outcomes

Abstract

Background: A devolution is a form of decentralisation or the transfer of authority and responsibility from central to lower levels of government for a range of public functions. The drafters of the 2010 Kenyan constitution chose to devolve functions to 47 newly created counties. In Kenya, health is a devolved function that county governments run. Tuberculosis is managed at the county level in coordination with the National Leprosy Tuberculosis and Lung Disease Program (NLTP) with a mission of End TB Strategy to achieve a 95% decline in deaths due to tuberculosis compared with the 2015 baseline and reach an equivalent 90% reduction in tuberculosis incidence rate. Methods: This was a retrospective cohort study that collected data from health facilities accredited by the NLTP for drug-resistant tuberculosis treatment. The study population included patients who tested positive for drug-resistant tuberculosis from 2014 to 2019. Data was sourced from NLTP Electronic Medical Records (TIBU-System). After abstraction, the data was entered into Excel and analysed through STATA software version 13. Results: Of the 2674 enrolled patients in total, there were more males affected with DRTB at 64 % compared to the female patients. The public facilities carried the immense burden of diagnosis and treatment of the patient, having a cumulative number of 83 %, while the prison sector had the lowest number. For the resistance pattern, the new, relapse, and failure of first-line drugs accounted for most drug-resistant cases at 80 %, with only 65 % of the total cases having been done a gene-expert test at the point of screening. Conclusion: With a devolved health unit in Kenya, there needs to be a more coordinated support system from the national government to the county health units in terms of surveillance of TB disease. Regional centralised laboratories for diagnosis and monitoring of TB would reduce the time it takes for samples to come to Nairobi for testing, which takes time before patents are initiated on treatment.