TB Services Research Articles

Barriers and Enablers to Implementing TB Control Strategies in EU and EEA Countries: A Systematic Review

Background: Meeting the 2035 WHO targets of reducing TB incidence by 90% requires the implementation of country-specific TB control strategies. This systematic review aims to identify factors which facilitate or impede the implementation of such strategies in EU/EEA settings. Focusing on providers of care, health system constraints and social and political factors, this review complements available evidence on the accessibility of TB services to recipients of care. Methods: We included publications that analysed empirical data on TB policies, strategies, guidelines or interventions. Databases were searched for papers published in EU/EEA countries between January 1997 and May 2017. Relevant phrases were coded and analysed using descriptive, thematic and network plot techniques. Findings: Of the 1,471 papers screened, 49 were included. The most common barrier to TB control strategies described the divergence of healthcare practices from guidelines. This often related to limited knowledge or perceived usefulness of the guideline by clinicians. Lack of appropriate human resources was another common barrier. The most commonly identified enabler to TB control strategies was the documented positive attitudes of healthcare workers towards TB programmes. Interpretation: Divergence between clinical practice and guidelines was described in most EU/EEA settings, indicating the need for a focused review of guideline adherence. Strengths of this study involve its broad inclusion criteria and wide range of TB control strategies analysed. Funding Statement: This study is part of the E-DETECT TB project (ref. 709624) which has received funding from the European Union’s Health Programme (2014-2020). PROSPERO (CRD42017060100). Declaration of Interests: We declare no competing interests.

Integrating psycho–social counselling in TB Services in Armenia

Abstract Background Community or family-based DOT improves clinical outcomes and quality of life of TB patients compared to facility-based DOT. Based on a previously conducted clinical trial and recommended best practice guidelines, Armenia started the institutionalization of the family-based DOT in 2019, as an important component of the integrated people-centered approach in TB treatment. Psycho-social counselling and education played a crucial role in preparing patients/family members for this new model of care. Methods To facilitate the family-based DOT, multidisciplinary counseling teams consisting of a TB nurse and a psychologist or a TB nurse and a social worker were formed and further incorporated into the existing TB care system. After a systematic evaluation the strongest applicants were shortlisted, interviewed, and selected. They underwent a three-day training, improving their knowledge on TB disease, its transmission, diagnosis and treatment; patient counseling with an emphasis on motivational interviewing techniques; and people-centered TB care. A comprehensive package of procedural documents was developed to facilitate the counseling teams work process, including a guideline on counseling, reporting forms, and patients' educational materials. At an early stage of TB treatment, the counseling teams provide psycho-social counselling to patients and their families, and educate them on TB risk factors and infection control. Results The counselling teams have been based in the National Center of Pulmonology of the RA and provide psycho-social counselling to all drug susceptible TB patients and their family members all over Armenia. The counseling teams prepare patients/family members for the family-based DOT and provide continuous support during the entire treatment. The integration of counselling teams in the TB care system has provided the required human resource and capacity for the successful adoption of a new model of people-centered TB care in Armenia.

Moving towards people–centered approach in TB Health Care System: Armenia’s Experience

Abstract Background Achieving integrated people-centered care requires interventions at various levels of the system, including policy changes and measures tailored to strengthen skills and competencies of health care providers. The national guidelines for TB care provision in Armenia provide a standardized approach for TB diagnosis and treatment, including systematic implementation of TB care services across the country. Before August 2019, the only option for drug-sensitive TB treatment was facility-based DOT. Methods In order to offer an alternative treatment option- family- based DOT, and bring TB services closer to patients' needs and values, the national guideline for TB care provision was updated to institutionalize the new approach. A series of nationwide professional development trainings was launched to assure that health care providers at the inpatient and outpatient settings effectively follow the new updates in the national guideline. These evidence-based trainings specifically aimed to equip healthcare providers with the necessary tools, knowledge, and the skillset for communicating with TB patients and building relationship and trust, offering their professional support. Along with patient counselling skills, the curriculum covered recent updates on TB epidemic, its social-psychological and behavioral risk factors, and advancements in TB diagnosis and treatment. All the participants were provided with a manual and other materials regarding the program. Results The Ministry of Health of the RA has approved the national guidelines on TB care (No 2277 - Ô±, August 19). This document includes information on people-centered TB treatment and institutionalizes the family-based DOT in Armenia. More than 90 percent of TB healthcare providers (98 physicians and 134 nurses) throughout Armenia participated in the trainings and received certificates. The RA Ministry of Health accredited the training curriculum with 11 continuing medical education credits for participation.

Hospital inpatient care utilization among patients with tuberculosis, Republic of Ireland, 2015-2018.

The Republic of Ireland (ROI) has a low incidence of TB. A reform of TB services in 2003 recommended that the delivery of care to patients with TB should primarily be in the outpatient setting, with limited indications for hospitalization. Three hospitals were designated as TB centres. Our aim was to describe the utilization of hospital inpatient care by patients with TB in the ROI. We searched public hospital coding data to identify discharges between 01/01/2015-31/12/18 where TB was the principal diagnosis. The cost of TB episodes of care was calculated using payment rules for public hospitals in the ROI. We identified 1185 discharges with TB as the principal diagnosis. Of these, 68% (801/1185) were emergency episodes of care and 32% (384/1185) were elective. We estimate that 65.1% (818/1257) patients with TB notified in the ROI from 2015 to 2018 who had an episode of care in a public hospital was 65.1% (818/1257) and that 50.8% (639/1257) of those notified had an emergency episode of care. The estimated mean annual cost of TB inpatient care per year in the ROI from 2015 to 2018 was €2,638,828-2,955,047, with emergency episodes of care having a mean annual cost of €2,250,926-2,557,397 per year. The burden of TB on hospital inpatient care in the Republic of Ireland is significant.

General and tuberculosis-specific service readiness in two states in Nigeria

BackgroundTuberculosis is the world’s deadliest infectious disease and a leading cause of death in Nigeria. The availability of a functional healthcare system is critical for effective TB service delivery and attainment of national and global targets. This study was designed to assess readiness for TB service delivery in Oyo and Anambra states of Nigeria.MethodsThis was a facility-based study with a mixed-methods convergent parallel design. A multi-stage sampling technique was used to select 42 primary, secondary, and tertiary healthcare facilities in two TB high burden states. Data were collected using key informant interviews, a semi-structured instrument adapted from the WHO Service Availability and Readiness Assessment tool and facility observation using a checklist. Quantitative data were analysed using descriptive and inferential statistics while qualitative data were transcribed and analysed thematically. Data from both sources were integrated to generate conclusions.ResultsThe domain score for basic amenities in both states was 48.8%; 47.0% in Anambra and 50.8% in Oyo state with 95% confidence interval [− 15.29, 7.56]. In Oyo, only half of the facilities (50%) had access to constant power supply compared to 72.7% in Anambra state. The overall general service readiness index for both states was 69.2% with Oyo state having a higher value (73.3%) compared to Anambra with 65.4% (p = 0.56). The domain score for availability of staff and TB guidelines was 57.1% for both states with 95% confidence interval [− 13.8, 14.4]. Indicators of this domain with very low values were staff training for the management of HIV and TB co-infection and training on MDR -TB. Almost half (47.6%) of the facilities experienced a stock out of TB drugs in the 3 months preceding the study. The overall tuberculosis-specific service readiness index for both states was 75%; this was higher in Oyo (76.5%) than Anambra state (73.6%) (p = 0.14). Qualitative data revealed areas of deficiencies for TB service delivery such as inadequate infrastructure, poor staffing, and gaps with continuing education on TB management.ConclusionsThe weak health system remains a challenge and there must be concerted actions and funding by the government and donors to improve the TB healthcare systems.

Responding to COVID-19: adjusting TB services in a low-burden setting

Responding to COVID-19: adjusting TB services in a low-burden setting

Integrating tb-hiv services in community health centers in Kulon Progo District

Background: Indonesia is a country with a high burden of tuberculosis and the human immunodeficiency virus. In response, countries adopted WHO recommendations on integrated services, including diagnostic screening and care for TB-HIV patients. Kulon Progo seeks to improve services under existing health system resources, and it is very important to understand its capacity to provide integrated TB-HIV services. Objective: This study aims to assess the readiness of TB-HIV integrated services in Puskesmas for the health system in the Kulon Progo Regency. Method: The research method uses mixed methods explanatory sequential design. The unit of analysis is the Puskesmas. Observation of the availability and readiness of TB services and cross-sectional HIV services using SARA modified questionnaires, followed by in-depth interviews exploring barriers and opportunities for integration of TB-HIV services at the Puskesmas. Results: Puskesmas service readiness, 93.3% (95% CI; 92.7% -93.9). Puskesmas had the readiness to provide basic health services, 63.8% (95% CI, 60.7-66.8). Puskesmas TB service readiness, 80.9% (95% CI: 73.6–88.2) HIV test counseling service readiness, only 1 Puskesmas (4.7%) has readiness for both services. Based on the domain assessment, 40.4% of the Puskesmas had trained TB diagnosis and treatment officers, 61.9% had trained officers and HIV testing counseling guidelines. The dominant themes include non-supportive staffing, not optimal human resource capacity, the lack of coordination and teamwork, and lack of monitoring and supervision system. With the support of leaders and good policies to mobilize funding, the availability of facilities becomes an opportunity for integrated TB-HIV services to run. Conclusion: Towards readiness to integrate TB-HIV services under the TB-HIV collaboration recommendation, efforts to address the needs of the number of health workers and equip staff with knowledge and skills as capacity building to manage integrated care. The involvement and support of the leadership of the determinants of readiness to ensure the availability of facilities, diagnostic supplies, and medicines as a continuous implementation.

\u201cKnock Knock\u201d: a qualitative study exploring the experience of household contacts on home visits and their attitude towards people living with TB in South Africa

BackgroundHousehold contract tracing (HHCT) is an important strategy for active tuberculosis case finding and offers an opportunity for testing of other diseases such as HIV. However, there is limited data on the patient-centered approach to HHCT. Our study aimed to describe experiences and preferences of household contacts (HHCs) for HHCT.MethodsWe conducted a qualitative study in Rustenburg, South Africa from September 2013 to March 2015. Twenty-four HHCs (≥18 years) had audio-recorded in-depth interviews. We used an inductive thematic analysis approach to develop themes. We made an a priori assumption that we would reach saturation with at least 20 interviews.ResultsThere were 16 (66.7%) females (median age = 36 years) and eight (33.3%) males (median age = 34 years). Two themes developed: (i) Positive attitude of HHCs towards TB services provided at home and (ii) HHCs relationship to and acceptance of people living with TB (PLTB). The first main theme emphasized that HHCs appreciated the home visits. Participants preferred home visits because they had negative experiences at the clinic such as delayed waiting times and long queues. HHCs supported the screening of children for TB at home. Participants suggested that the research staff could expand their services by screening for diabetes and hypertension alongside TB screening. In the second main theme, there was a sense of responsibility from the HHCs towards accepting the diagnosis of PLTB and caring for them. A sub-theme that emerged was that as their knowledge on TB disease improved, they accepted the TB status of the PLTB empowering them to take care of the PLTB.ConclusionsHHCs are supportive of HHCT and felt empowered by receiving TB education that ultimately allowed them to better understand and care for PLTB. HHCs were supportive of screening children for TB at home. Future HHCT activities should consider raising community awareness on the benefits of TB contact tracing at households.

Financial incentive- Does this have impact on outcome of Tuberculosis?

Background: Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Primary objective: Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. Methodology: A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Results: Out of total 1430 patients inquired, 896 (62.7%) patients were found eligible for the scheme, while only 87 (9.7%) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. Conclusion: The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit.

\u201cDeath is a better option than being treated like this\u201d: a prevalence survey and qualitative study of depression among multi-drug resistant tuberculosis in-patients

BackgroundUnderstanding of the relationship between multi-drug resistant tuberculosis and mental health is limited. With growing prevalence of multi-drug resistant tuberculosis, addressing mental ill-health has potential to improve treatment outcomes and well-being. In several low and middle-income contexts hospitalisation during treatment is common. Understanding of the impact on mental ill-health are required to inform interventions for patients with multi-drug resistant tuberculosis.Our aim was to identify the prevalence of comorbid depression among in-patients being treated for multi-drug resistant tuberculosis and to explore their experiences of comorbid disease and the care they received in a large specialist chest hospital in Dhaka, Bangladesh.MethodsWe conducted a quantitative cross-sectional survey among 150 multi-drug resistant tuberculosis in-patients (new cases = 34%, previously treated = 66%) in 2018. A psychiatrist assessed depression was assessed with the Structured Clinical Interview for Depression (SCID DSM-IV). We used multi-level modelling to identify associations with depression. Experience Bangladeshi researchers conducted qualitative interviews with 8 patients, 4 carers, 4 health professionals and reflective notes recorded. Qualitative data was analysed thematically.ResultsWe found 33.8% (95% CI 26.7%; 41.7%) of patients were depressed. While more women were depressed 39.3% (95% CI 27.6%; 52.4%) than men 30.4% (95% CI 22%; 40.5%) this was not significant. After controlling for key variables only having one or more co-morbidity (adjusted odds ratio [AOR] = 2.88 [95% CI 1.13; 7.33]) and being a new rather than previously treated case (AOR = 2.33 [95% CI 1.06; 5.14]) were associated (positively) with depression. Qualitative data highlighted the isolation and despair felt by patients who described a service predominantly focused on providing medicines. Individual, familial, societal and health-care factors influenced resilience, nuanced by gender, socio-economic status and home location.ConclusionsPatients with multi-drug resistant tuberculosis are at high risk of depression, particularly those with co- and multi-morbidities. Screening for depression and psycho-social support should be integrated within routine TB services and provided throughout treatment.

Integrating pediatric TB services into child healthcare services in Africa: study protocol for the INPUT cluster-randomized stepped wedge trial

BackgroundTuberculosis is among the top-10 causes of mortality in children with more than 1 million children suffering from TB disease annually worldwide. The main challenge in young children is the difficulty in establishing an accurate diagnosis of active TB.The INPUT study is a stepped-wedge cluster-randomized intervention study aiming to assess the effectiveness of integrating TB services into child healthcare services on TB diagnosis capacities in children under 5 years of age.MethodsTwo strategies will be compared: i) The standard of care, offering pediatric TB services based on national standard of care; ii) The intervention, with pediatric TB services integrated into child healthcare services: it consists of a package of training, supportive supervision, job aids, and logistical support to the integration of TB screening and diagnosis activities into pediatric services. The design is a cluster-randomized stepped-wedge of 12 study clusters in Cameroon and Kenya. The sites start enrolling participants under standard-of-care and will transition to the intervention at randomly assigned time points. We enroll children aged less than 5 years with a presumptive diagnosis of TB after obtaining caregiver written informed consent. The participants are followed through TB diagnosis and treatment, with clinical information prospectively abstracted from their medical records.The primary outcome is the proportion of TB cases diagnosed among children < 5 years old attending the child healthcare services. Secondary outcomes include: number of children screened for presumptive active TB; diagnosed; initiated on TB treatment; and completing treatment. We will also assess the cost-effectiveness of the intervention, its acceptability among health care providers and users, and fidelity of implementation.DiscussionStudy enrolments started in May 2019, enrolments will be completed in October 2020 and follow up will be completed by June 2021. The study findings will be disseminated to national, regional and international audiences and will inform innovative approaches to integration of TB screening, diagnosis, and treatment initiation into child health care services.Trial resistrationNCT03862261, initial release 12 February 2019.

Perspective Of Stakeholders On The Sustainability Of Tuberkulosis Program

This research is a type of descriptive research using a qualitative approach design using a case study research design. Funding for the TB program in Pasuruan Regency was sourced from the APBD and also Health Operational Assistance sourced from the Special Allocation Fund decreased. The budget for TB prevention prevention programs is absorbed entirely But the performance of achieving the discovery targets is still not significant. Still not found the whole case, complete treatment has not been maximized, some even DO. TB control activities allocated for TB prevention and control services appear to be relatively small compared to the TB treatment budget. Based on all the challenges faced, a strategy was formulated to eliminate TB within the next 5 years by strengthening the leadership of a quality TB service program with a sustainable program across stakeholders

Using hospital auxiliary worker and 24-h TB services as potential tools to overcome in-hospital TB delays: a quasi-experimental study

BackgroundIn-hospital logistic management barriers (LMB) are considered to be important risk factors for delays in TB diagnosis and treatment initiation (TB-dt), which perpetuates TB transmission and the development of TB morbidity and mortality. We assessed the contribution of hospital auxiliary workers (HAWs) and 24-h TB laboratory services using Xpert (24h-Xpert) on the delays in TB-dt and TB mortality at Beira Central Hospital, Mozambique.MethodsA quasi-experimental design was used. Implementation strategy—HAWs and laboratory technicians were selected and trained, accordingly. Interventions—having trained HAW and TB laboratory technicians as expediters of TB LMB issues and assurer of 24h-Xpert, respectively. Implementation outcomes—time from hospital admission to sputum examination results, time from hospital admission to treatment initiation, proportion of same-day TB cases diagnosed, initiated TB treatment, and TB patient with unfavorable outcome after hospitalization (hospital TB mortality). A nonparametric test was used to test the differences between groups and adjusted OR (95% CI) were computed using multivariate logistic regression.ResultsWe recruited 522 TB patients. Median (IQR) age was 34 (16) years, and 52% were from intervention site, 58% males, 60% new case of TB, 12% MDR-TB, 72% TB/HIV co-infected, and 43% on HIV treatment at admission. In the intervention hospital, 93% of patients had same-day TB-dt in comparison with a median (IQR) time of 15 (2) days in the control hospital. TB mortality in the intervention hospital was lower than that in the control hospital (13% vs 49%). TB patients admitted to the intervention hospital were nine times more likely to obtain an early laboratory diagnosis of TB, six times more likely to reduce delays in TB treatment initiation, and eight times less likely to die, when compared to those who were admitted to the control hospital, adjusting for other factors.ConclusionIn-hospital delays in TB-dt and high TB mortality in Mozambique are common and probably due, in part, to LMB amenable to poor-quality TB care. Task shifting of TB logistic management services to HAWs and lower laboratory technicians, to ensure 24h-Xpert through “on-the-spot strategy,” may contribute to timely TB detection, proper treatment, and reduction of TB mortality.

User experience and patient satisfaction with tuberculosis care in low- and middle-income countries: A systematic review

BackgroundPatient-centered care is at the forefront of the End TB strategy, yet little is known about user (patient's) experience and patient satisfaction with TB services. Our study aims to systematically review quantitative studies evaluating user experience and TB patient satisfaction within the health care system. MethodsFive medical databases were systematically searched between January 1st, 2009 and December 31st, 2018. English studies assessing user experience and patient satisfaction within the healthcare system from a TB patient's perspective in low and middle-income countries, were included. ResultsThirty-five studies from 16 low and middle-income countries evaluated three major themes; facilities and patient centeredness (n = 23), patient-provider relationship (n = 22) and overall satisfaction (n = 19). Overall study quality was low as they used varying tools to measure user experience and patient satisfaction. ConclusionOur study shows large variability in measurement of user experiences and patient satisfaction. Studies reported that patients were mostly satisfied with TB care services, and those that were dissatisfied were substantially more likely to be lost to follow-up. The high satisfaction rates could have been due to lack of education on good quality patient care or fear of losing access to health care. A standardized patient centered tool could be designed to help assess user experience and patient satisfaction to allow comparisons among health systems and countries.

The regent's involvement with the village of peduli TBC (tuberculosis)

TBC is still a serious problem for the government to date. TBC services are still widely available in urban areas, making it difficult for some people in rural areas to access services. Village-based TB services, if any, are still not optimal for prevention, even if they exist, they are only perfunctory. TB Care Village is expected to be able to accelerate the prevention and control of TB. The service program TB Care Village can be reached by all people, especially TB sufferers, which include : TB sufferers obey medical services, provision of additional TB nutrition and Rewards Service providers face the population directly. A public health service officer called P2M is assisted by a female health cadre, are recruited from local residents who understand the local culture.

Protocol for a cluster randomised control trial evaluating the efficacy and safety of treatment for latent tuberculosis infection in recent migrants within primary care: the CATAPuLT trial

BackgroundThe identification and treatment of LTBI is a key component of the WHO’s strategy to eliminate TB. Recent migrants from high TB-incidence countries are recognised to be at risk TB reactivation, and many high-income countries have focused on LTBI screening and treatment programmes for this group. However, migrants are the group least likely to complete the LTBI cascade-of-care. This pragmatic cluster-randomised, parallel group, superiority trial investigates whether a model of care based entirely within a community setting (primary care) will improve treatment completion compared with treatment in specialist TB services (secondary care).MethodsThe CATAPuLT trial (Completion and Acceptability of Treatment Across Primary Care and the community for Latent Tuberculosis) randomised 34 general practices in London, England, to evaluate the efficacy and safety of treatment for LBTI in recent migrants within primary care. GP practices were randomised to either provide management for LTBI entirely within primary care (GPs and community pharmacists) or to refer patients to secondary care. The target recruitment number for individuals is 576. The primary outcome is treatment completion (defined as taking at least 90% of antibiotic doses). The secondary outcomes assess adherence, acceptance of treatment, the incidence of adverse effects including drug-induced liver injury, the rates of active TB, patient satisfaction and cost-effectiveness of LTBI treatment. This protocol adheres to the SPIRIT Checklist.DiscussionThe CATAPuLT trial seeks to provide implementation research evidence for a patient-centred intervention to improve treatment completion for LTBI amongst recent migrants to the UK.Trial registrationNCT03069807, March 2017, registered retrospectively.

The SORT IT model for building operational research capacity: the experience of TB service providers in PNG

The SORT IT model for building operational research capacity: the experience of TB service providers in PNG

Spatio-Temporal Distribution of Tuberculosis in an Urban Setting in Germany.

Big cities in Europe have the highest incidence rates of TB in otherwise low incidence settings. Understanding of the spatio-temporal patterns of TB incidence can support efforts for TB prevention and control in line with the End-TB Strategy of the WHO in such settings for low incidence settings. Data from the municipal TB register of Cologne collected between 2006 and 2015 under the infection prevention legislation were retrieved, addresses geographically identified and all notified incident TB cases retrospectively analysed for their spatial and temporal distribution in this large German city using a geographic information system. During the analysed period 1,038 incident cases were reported, equivalent to an incidence rate of 10.03 cases per 100,000 inhabitants. Contagious pulmonary TB contributed 57 % of all cases. Distribution patterns changed over time with decreases in 37 and increases in 22 of the 77 urban sub-districts, three of which showing constant high rates of TB incidence. The study presents a complementary method to monitor the distribution and development of incident TB cases at a disaggregated level of urban sub-districts. Identification of areas with comparatively high incidence can support identification of clusters respectively their prevention and allow better planning for targeted local TB services.

Access of Key Population to Available HIV and TB Services in Nepal: A Cross Section Study

Introduction: TB is considered one of the opportunistic infection among PLHIV. The increasing burden of HIV/TB co-infection among key population cause problem to maintain adherence to ART and DOTS services. The emergence of MDR-TB is one of the greatest challenge to control and management of both diseases. However, having knowledge and information of both diseases are important role to access the available HIV/TB services.&#x0D; Methods: A cross-sectional survey was conducted among key population who had HIV/TB co-infection in two-epidemic zone of Nepal. A pretested semi-structured questionnaire was used to collect data. ANOVA test was done to analyze the collected data by using SPSS version 20.0.&#x0D; Results: A total of 343 HIV/TB co-infected individuals were enrolled to the study. Most of participants were from ART and DOTS clients. Therefore, the study found that there was significance difference found between knowledge about TB (F=4.400, p= 0.005), causative agent of TB (F=3.160, p=0.025), risk of TB illness among PLHIV (F=8.491, p=0.001) and among key affected population. Moreover, there was significance difference found between access to OI treatment (F=5.113, p=0.002) and access to viral load (F=4.642, p=0.003) among key study population. In gender perspective, there was no significance difference to use and access to available HIV/TB services.&#x0D; Conclusion: The general knowledge on HIV/TB co-infection was significant association with key population. The knowledge on HIV/TB and access to NGOs’ help can significant effect to access the available HIV and TB services.

Tuberculosis in Nepal: Situation, Challenges and Ways Forward

Introduction: Globally, tuberculosis is a major public health problem. Moreover, the emergence of drug resistant forms of TB has threatened TB prevention and treatment efforts. Despite the long history of tuberculosis prevention efforts, tuberculosis still ranks among the top ten causes of deaths in Nepal. Furthermore, Nepal being land locked with two high TB burden countries i.e. India and China, it has added difficulties to National Tuberculosis program. Hence this study aims to review the situation of National Tuberculosis Program in Nepal and explore the possible challenges and ways forward for NTP to strengthen the TB diagnostics and treatment services in Nepal.&#x0D; Methods: This study is based on the review of available literatures and data sources related to tuberculosis prevention, care and control. Secondary data published by National Tuberculosis Program in the annual report for the year 2015, 2016 and 2017 were considered for the situation analysis of tuberculosis in Nepal. We used different platforms like Google scholar, PubMed to search relevant literatures.&#x0D; Results: This has been a huge gap between WHO TB estimates and TB cases notification by the national system. It was 22% in 2015, 27% in 2016 and 29% in 2017. However National Tuberculosis Program has maintained treatment success rate consistently above 90%. Tuberculosis program has yet not achieved universal HIV testing, although HIV testing among TB patients has increased rapidly. Similarly, only 75%, 1994 received DST out of 2601 retreatment TB cases have received DST in 2017 despite guideline suggest mandatory drug susceptibility testing for retreatment TB cases.&#x0D; Conclusion: Case notification has reduced gradually. It is difficult to achieve the target envisioned by NSP 2016-21 if the current case notification trend persists. NTP needs to expand service sites ensuring minimum quality standards as well as scale up targeted intervention addressing human right issues to identify the missing TB cases. NTP needs to regulate the quality of diagnosis and treatment TB services offered by private sector.