The referral pathway of presumptive drug resistant tuberculosis in the urban poor areas of Metro Manila, Philippines

Abstract

Background: The National Tuberculosis Control Program (NTP) guidelines emphasize that all presumptive Drug Resistant Tuberculosis (DRTB) with history of previous tuberculosis (TB) treatment and with Multi-Drug Resistant Tuberculosis (MDRTB) contacts should be screened for MDR. Due to lack of tools to identify the referral outcome of presumptive DRTB, the RJPI developed an MDRTB Presumptive Masterlist to account referrals from health center to MDR treatment center. The study aims to understand gaps in the referral pathway experienced by Local Government Units (LGUs) and Non-Government Organizations (NGOs) from initial consultation until initiation of treatment. Methods & Materials: A retrospective descriptive study of patients’ data registered on MDRTB Presumptive Masterlist of eighteen Directly Observed Treatment Short-Course (DOTS) facilities in District 1 Tondo, Manila and Payatas, Quezon City from October 2012 to September 2013, were reviewed and analyzed using structured questionnaire. Unpaired t-test used in comparing the turnaround time between LGUs and NGOs including time between Direct Sputum Smear Microscopy (DSSM) results presented to patient and referred to MDR treatment center. A p-value < 0.05 was considered statistically significant. All analysis performed using EZR with graphical user interface for R. Results: A total of 378 Presumptive DRTB was identified and listed in the masterlist. Among them, 97% (368/378) referred and 90% (333/368) screened at MDR Treatemnt center. Among screened, 85% (283/333) completed the process of MDR screening and provided with an appropriate treatment based on NTP guidelines. 9.5% (35/368) were not screened mainly due to lost to follow up. The duration of time between sample collected and examined at laboratory of NGOs was significantly longer than LGUs (n = 283; p < 0.001). The time duration between the release of DSSM results and presentation of patient at NGOs was significantly shorter than LGUs (p = 0.009). Conclusion: Development of MDRTB Presumptive Masterlist has facilitated tracking of patients due for diagnosis and treatment. Referral system between health center and MDR treatment centers should be strengthened for proper patient endorsement and provided with an appropriate action. The NGOs should lessen diagnosis delays and LGUs should follow up patient for early start of TB treatment.