Delivery Of Tuberculosis Care Research Articles

Effectiveness of Mobile Application to Improve Adherence to Tuberculosis Treatment: A Study Protocol

Introduction: Tuberculosis (TB) is a leading cause of death due to a single infectious agent. The disease is treatable by a minimum of six months of anti-TB drugs. However, prolonged duration of treatment using directly observed therapy (DOT) causes significant inconvenience to patients and is ineffective in improving treatment outcomes. Therefore, incorporating the Health Belief Model into the development of digital technology could help change behaviour and improve adherence. This study aimed to determine the effectiveness of mobile applications in improving TB medication adherence. Methods: This study proposed to conduct a randomized trial among TB patients in the Kota Kinabalu, Penampang, and Putatan districts of Sabah, Malaysia. The eligible sample will be randomly assigned to the mobile application DOT arm and standard DOT arm. The primary outcome is the adherence level calculated by the percentage of medication observed divided by the intended dose taken in two months, with 80% and more successfully observed treatment considered highly adherent. The secondary outcomes are health-related quality of life, satisfaction, and monthly household income. Multiple logistic regression and repeated measures ANCOVA will be used to determine the effectiveness of interventions to achieve primary and secondary outcomes. Discussion: The findings from this study could hopefully provide insight into rethinking TB care delivery to achieve better TB treatment outcomes. Trial Registration: This study protocol has been approved by the Medical Research Ethics Committee (MREC), Ministry of Health Malaysia (NMRR ID-21-01949-73X) and registered with ClinicalTrials.gov (NCT05259254).

Impact of the COVID-19 Pandemic on tuberculosis management in India: A Brief Overview

Chronicles suggests that emerging and re-emerging viral infections disrupting the normal lifestyle of humankind, whether in the form of HIV, Ebola, Influenza, Nepah, or the current SARS-CoV-2 pandemic. Such viral infections disrupt the healthcare system along with the prevention and control of epidemics and pandemics, resulting in an increased burden of such diseases in the post-pandemic period. Tuberculosis (TB) routine services are interfered with by severe lockdowns due to the new COVID-19 virus. This article tried to measure the long-term epidemiological effects of such interruptions on TB prevalence in high-burden countries. The participating facilities performed a comprehensive review based on modifications to the care of TB patients during the COVID-19 pandemic. Retrospectively, clinical factors and household contact information were collected from a literature survey. Researchers looked at numerous strategies over the following five years to see whether they might lessen the effects on TB incidence and death. Present comprehensive literature was collected and analyzed using suitable keywords such as "COVID-19," "Pandemics," "Tuberculosis," and "India" during the current COVID-19 pandemic to investigate the influence of COVID-19 on tuberculosis management. The present article looks at the effects of the breaks in the delivery of TB care in hospital and primary care settings. Lockdown, social isolation, measures to prevent viral transmission, and public health guidelines impacted tuberculosis care. The present study revealed that the COVID-19 pandemic has adversely affected numerous TB prevention, monitoring, and treatment programs. Still, these adverse effects are diminished by the prompt restoration of TB services and the application of particular therapies as soon as restrictions are lifted.

Under-Reporting of Tuberculosis Disease among Children and Adolescents in Low and Middle-Income Countries: A Systematic Review

Under-reporting of tuberculosis (TB) disease in children and adolescents is a significant global concern, as many children are missing from TB notification data. A systematic literature review was conducted to understand the global reporting gap of child and adolescent TB as well as current interventions to close this gap in Low- and Middle- Income Countries (LMIC). Our study found large and variable gaps in child and adolescent TB reporting, due to various factors. Interventions to close this gap exist but are limited. Future studies are necessary to improve global surveillance systems to improve TB care delivery for children and adolescents.

All eyes on COVID-19, let's not forget Tuberculosis

Tuberculosis (TB) is a severe global threat killing more than one million people annually (WHO). With a successful TB control programme in place, there has been a decrease in the number of TB cases and deaths globally over recent years. The World Health Organisation (WHO) End TB Strategy has been momentously shocked by the COVID-19 pandemic and it seems that any success made over recent years is likely to be reversed. We are now more than one year into the pandemic, and the effect COVID-19 has had on TB services is devastating. Hospitals typically dedicated to TB have been converted to COVID-19 hospitals and diagnostic laboratories focus on COVID-19 testing rather than TB. Delivery of TB care is being prioritised for people who have active TB disease whereas prevention and diagnosis of latent TB infection (LTBI) is being put on hold. This pause can lead to an increase in TB cases and transmission. Here, we discuss the connection between SARS-CoV-2 infection and latent TB and highlight the importance of TB prevention management in LTBI post-COVID-19 patients. Community engagement and contact tracing are of high importance in fighting TB in the post-COVID19 era. Getting back on track with TB progress is essential, thus further modelling on the COVID-19 impact on TB burden and its determinants is critical.

Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression

Pulmonary tuberculosis masquerading as coronavirus disease 2019 in an HIV-infected individual with advanced immune suppression

"Treatment is of primary importance, and social assistance is secondary": A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia.

BackgroundVulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour.AimTo examine the influence of TB service organisation and culture on patients’ experience of starting and staying on treatment in Riga, Latvia.MethodsAn intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care.ResultsThe organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff.ConclusionProviding support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patient-related rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.

Barriers to tuberculosis care delivery among miners and their families in South Africa: an ethnographic study.

South African miners suffer the highest tuberculosis (TB) rates in the world. Current efforts to stem the epidemic are insufficient. Historical legacies and persistent disease burden demand innovative approaches to reshape health care delivery to better serve this population. To characterize social and behavioral health determinants for successful TB care delivery and treatment from the perspective of miners/ex-miners, health care workers and policy makers/managers. We conducted applied ethnography with 30 miners/ex-miners, 13 family/community members, 14 health care providers, and 47 local policy makers/managers in South Africa. Miners/ex-miners felt health care delivery systems failed to meet their needs. Many had experienced unnecessary physical and psychological harm due to limited health education about TB, minimal engagement in their own care, lack of trust in providers, and a system that did not value their experience. Stigma and fear associated with TB result in denial of symptoms and delays in care seeking. Health care providers and policy makers/managers felt discouraged by system constraints in providing optimal care. Our findings describe long-term effects of perpetual TB misinformation and stigma resulting from fear and disempowerment among miners and their families/communities. To reduce the TB burden, there is an urgent need to co-design a care delivery system with miners to better meet their needs.

Equitable tuberculosis care in the North West of England: analysis of tuberculosis cohort review data

SUMMARYBACKGROUND: In the United Kingdom, tuberculosis (TB) predominantly affects the most deprived populations, yet the extent to which deprivation affects TB care outcomes is unknown.METHODS: Since 2011, the North West TB Cohort Audit collaboration has undertaken quarterly reviews of outcomes against consensus-defined care standard indicators for all individuals notified with TB. We investigated associations between adverse TB care outcomes and Index of Multiple Deprivation (IMD) 2010 scores measured at lower super output area of residence using logistic regression models.RESULTS: Of 1831 individuals notified with TB between 2011 and 2014, 62% (1131/1831) came from the most deprived national quintile areas. In single variable analysis, greater deprivation was significantly associated with increased likelihood of the completion of a standardised risk assessment (OR 2.99, 95%CI 5.27–19.65) and offer of a human immunodeficiency virus test (OR 1.72, 95%CI 1.10–2.62). In multivariable analysis, there were no significant associations.CONCLUSIONS: TB patients in the most deprived areas had similar care indicators across a range of standards to those of individuals living in the more affluent areas, suggesting that the delivery of TB care in the North West of England is equitable. The extent to which the cohort review process contributes to, and sustains, this standard of care deserves further study.

Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery.

The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science-the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed-is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.

The European Union standards for tuberculosis care: do they need an update?

The International Standards for Tuberculosis Care (ISTC), published for the first time in 2006 [1], introduced a new way of looking at clinical and public health guidelines for tuberculosis (TB). The European Respiratory Journal published an editorial explaining the ISTC, promoting the rapid uptake of the standards [2]. While guidelines represent a long, comprehensive document containing all the details the physician might need for managing TB, the standards are a simple set of 21 principles that guide day-to-day clinical decisions [3, 4]. In other words, guidelines are usually available in a physician’s library while the standards are kept on their desk in the office. The ISTC prescribe a widely accepted level of TB care which guides all healthcare providers and clinicians, both public and private, in achieving optimal standards in managing patients who have, or are suspected of having, active TB [1–4]. The European Centre for Disease Prevention and Control (ECDC) and the European Respiratory Society (ERS) jointly developed a European Union (EU) adaptation of the ISTC document, known as the European Union Standards for Tuberculosis Care (ESTC) [4]. These standards are tailored to the specific context of the EU/European Economic Area (EEA) as follows [4, 5]. 1) Although the majority of EU/EEA member states have a low incidence of TB, it is a heterogeneous setting with some countries having a high or intermediate level of TB, with varying levels of multidrug-resistant (MDR)-TB and TB-HIV co-infection, and some countries bordering non-EU countries with a higher TB and MDR-TB burden. 2) TB services are fully integrated and merged within the health system in the majority of EU/EEA member states. This presents peculiarities in allocating responsibilities for the delivery of TB care. 3) The EU/EEA member …

Assessment of the quality of service given by health care provider about tuberculosis in RNTCP

Sir, The directly observed therapy short-course (DOTS) is an effective and widely accepted strategy for TB control. Few countries find success in expanding DOTS coverage to enough people to meet global targets. The main constraints to achieving the global targets include lack of political commitment, insufficient and ineffective use of financial resources, neglect of human resource development, poor health system organization, poor quality and an irregular supply of anti-TB drugs, and weak communication components in TB control programs.[1] This study was conducted in Davangere of Karnataka state in India a) to assess the quality of service in the delivery of tuberculosis care, b) to evaluate client satisfaction with the government approach and c) to assess utilization of facilities by the community. Multistage sampling was done. The district was stratified into taluks. There are 6 taluks, so 6 PHC, 5 PHU and 1 CHC in this district. Totally, 12 health centers were selected. The sample constituted 12.25% of the total health centers of Davangere.[2] A ‘rule of thumb’ was used for the rough estimation of sample size.[3] Quality assessment was done using the above rule where in each health centre had total service provider 100, 10% of the houses were sampled. When the household exceeded 50, 20% of the households were taken and when it was <50, 30% of the households were sampled.[3] Using this method, the total number of households were found to be 478 in the district. The areas covered by JHW (F) sampled for quality of work were also taken for the survey of utilization of services. Module 6 of Agha Khan Foundation was used for quality assessment of services. The questionnaires were modified according to local needs and was pretested before data were collected.[3] Single observer was used to avoid bias for viewing the services. Not a single client was interviewed in front of any service provider so that strict confidentiality was maintained. Client satisfaction was assessed based on time span, referred system, facilities etc. A total of 9 out of 12 centres dealt with tuberculosis, no health worker or doctor was present in one center, patients were directly sent to DTC in one urban center, and finally one sub-centre area did not cater the required service, instead the patients were directly referred to higher centre. History taking was well done (64.82%), 89% health workers asked about cough, 100% asked about fever, and 66% asked for blood in sputum and weight loss, but only 22% tried to find out the source of infection. Examination of the patient was satisfactory. Their work was excellent in those areas where doctor was present full time. 100% of the health workers auscultated the lungs, only 22% took temperature and weighed patients, and 78% of the health workers examined the lymph nodes of patients. Referral was done and treatment was given in almost all centers (97.22%). Follow-up of cases was well done (81.48%). All centres had adequate supplies (100%). However, health education given to patients with tuberculosis was very poor (45.83%). 100% of the health workers told about lab tests and completion of treatment. Only 22% told about the spread and contagiosity of disease, 33% told about the follow-up. None told about the adverse effects of treatment and no patients were allowed to ask any question. Service provider’s knowledge was excellent and the patients’ knowledge was also good, as evident from the exit interview of the patients. Tuberculosis care was good on the whole. But health education was average because there was no emphasis on health education in RNTCP which is reflected by the service provider, similar to the findings of the earlier study.[4] Because of excessive importance to RNTCP, both knowledge and practice about tuberculosis was good. This is unlike the results of earlier studies.[4,5] Client satisfaction was very good, except 53.33% felt that facilities and equipments were poor, because most of the centers did not have microscope and patients were referred to other centers which was not felt as appropriate. Also the clients were not happy with the time of referral as reported in an earlier study.[6] The clients were dissatisfied because they did not get proper answers about treatment and side-effects, also some of their questions were not answered. 13% were not satisfied about the duration of waiting. In an earlier study[6] utilization of services was found to be not satisfactory, but we have 100% utilization and we assume that the emphasis on RNTCP might have made it more user friendly, which is similar to the findings of a Tanzania-based study.[7]

Quality of tuberculosis care and its association with patient adherence to treatment in eight Ethiopian districts

Little is known about the quality of tuberculosis (TB) service delivery in public health facilities in Ethiopia and its association with patients' non-adherence to TB treatment. This study assessed the organization, management and processes of TB care delivery, and their effects on patients' adherence to TB treatment. The quality of TB care was investigated in 44 public health facilities from three perspectives: structure, processes of TB care delivery and patient treatment outcome. Quality of care was determined by adherence to national TB guidelines. On-site observations of TB service delivery and interviews with health providers were conducted to evaluate structural factors. Patients (n = 237) in the health facilities were interviewed prospectively at completion of their treatment to determine the quality of tuberculosis care delivered. Three measures of treatment adherence [treatment interruption (>or=2 weeks), availability of unused TB drugs and treatment default] were quantified from a review of patient treatment registers and an audit of unused TB drugs at patients' homes. Effects were identified of poor quality structures and processes of service delivery on these three measures of adherence. TB care providers were untrained in 18 (44%) of 44 facilities and daily outpatient TB care was not given in 13 of 44 (25%). Among the 237 patients, 43% interrupted treatment for >or=15 days and 30% had at least 1 day's dose of TB drugs unused. Patients tended to interrupt and default from treatment when their care provider had been inadequately supervised by district TB control experts and was incapable of dealing with patients' minor illnesses. Unavailability of daily TB care in health facilities was associated with missing daily doses. Better training of TB care providers and district supervisory support could be important interventions to improve the quality of care delivery and patient adherence to treatment.