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Jonathan J, Barakabitze AA. ML technologies for diagnosing and treatment of tuberculosis: a survey. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-023-00727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Owais SS, Horner RD, Khan MA, Kenison K, Probst JC. Integrating maternal depression care at primary private clinics in low-income settings in Pakistan: A secondary analysis. Front Glob Womens Health 2023; 4:1091485. [PMID: 37091298 PMCID: PMC10117980 DOI: 10.3389/fgwh.2023.1091485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction The prevalence of depression among women in Pakistan ranges from 28% to 66%. There is a lack of structured mental healthcare provision at private primary care clinics in low-income urban settings in Pakistan. This study investigated the effectiveness and processes of a facility-based maternal depression intervention at private primary care clinics in low-income settings. Materials and methods A mixed-methods study was conducted using secondary data from the intervention. Mothers were assessed for depression using the Patient Health Questionnaire-9 (PHQ-9). A total of 1,957 mothers (1,037 and 920 in the intervention and control arms, respectively) were retrieved for outcome measurements after 1 year of being registered. This study estimated the effectiveness of the depression intervention through cluster adjusted differences in the change in PHQ-9 scores between the baseline and the endpoint measurements for the intervention and control arms. Implementation was evaluated through emerging themes and codes from the framework analysis of 18 in-depth interview transcriptions of intervention participants. Results Intervention mothers had a 3.06-point (95% CI: -3.46 to -2.67) reduction in their PHQ-9 score at the endpoint compared with their control counterparts. The process evaluation revealed that the integration of structured depression care was feasible at primary clinics in poor urban settings. It also revealed gaps in the public-private care linkage system and the need to improve referral systems. Conclusions Intervening for depression care at primary care clinics can be effective in reducing maternal depression. Clinic assistants can be trained to identify and deliver key depression counseling messages. The study invites policymakers to seize an opportunity to implement a monitoring mechanism toward standard mental health care.
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Affiliation(s)
- Syeda Somyyah Owais
- Centre for Healthcare Resilienceand Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Correspondence: Syeda Somyyah Owais
| | - Ronnie D. Horner
- Department of Health Services Research & Administration, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Kelli Kenison
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, United States
| | - Janice C. Probst
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, United States
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Ebrahimoghli R, Ghobadi H, Adham D, Jangi P, Abbasi-Ghahramanloo A, Moradi-Asl E. The probability of diagnostic delays for tuberculosis and its associated risk factors in northwest Iran from 2005 to 2016: a survival analysis using tuberculosis surveillance data. Epidemiol Health 2022; 44:e2022060. [PMID: 35879855 PMCID: PMC9754906 DOI: 10.4178/epih.e2022060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/18/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Early diagnosis is essential for effective tuberculosis (TB) control programs. Therefore, this study examined the risk of delays in TB diagnosis and associated factors in Ardabil Province in northwest Iran from 2005 to 2016. METHODS This longitudinal retrospective cohort study was conducted using data obtained from the Iranian National Tuberculosis Control Program at the provincial level between 2005 and 2016. The total delay in diagnosis was defined as the time interval (days) between the onset of symptoms and TB diagnosis. Survival analysis was conducted to analyze the delay in diagnosis. Associated factors were identified using a Cox proportional hazards model. RESULTS A total of 1,367 new TB cases were identified. The 12-year median diagnostic delay was 45 days (interquartile range [IQR], 30-87). The annual median diagnostic delay decreased from 68 days (IQR, 33-131) in 2005 to 31 days (IQR, 30-62) in 2016. The probability of a delay in TB diagnosis decreased by 5.0% each year (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.04 to 1.07). Residence in a non-capital county (HR, 0.83; 95% CI, 0.74 to 0.92) and referral from the private health system (HR, 0.74%; 95% CI, 0.65 to 0.84) were significantly associated with an increased risk of delay in TB diagnosis over the 12-year study period. CONCLUSIONS The median delay decreased during the study period. We identified factors associated with a longer delay in TB diagnosis. These findings may be useful for further TB control plans and policies in Iran.
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Affiliation(s)
- Reza Ebrahimoghli
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hassan Ghobadi
- Division of Pulmonary, Department of Internal Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Davoud Adham
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Parviz Jangi
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Abbas Abbasi-Ghahramanloo
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Eslam Moradi-Asl
- Department of Public Health, School of Health, Ardabil University of Medical Sciences, Ardabil, Iran
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Sahasrabudhe T, Barthwal M, Sawant T, Ambike S, Jagtap J, Hande S, Atre S. Tuberculosis notification: An inquiry among private practitioners in Pimpri-Chinchwad municipal corporation area of Maharashtra, India. Indian J Tuberc 2022; 69:73-78. [PMID: 35074154 DOI: 10.1016/j.ijtb.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/28/2021] [Accepted: 04/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Government of India implemented mandatory TB notification policy since 2012. After that India's TB notifications from the private sector steadily increased; however, less is known about private practitioners' (PP's) experiences with TB notification. The present study aims to fulfil this gap. METHODS We conducted a cross-sectional study during November 2019 to March 2020 in Pimpri-Chinchwad Municipal Corporation (PCMC) area of Maharashtra State. We used a mixed methods approach which involved a survey of 200 PPs and in-depth interviews (IDIs) with 7 PPs and 8 National TB Elimination Program (NTEP) staff. The data were presented in the form of frequencies and percentages and thematic analysis was performed on the qualitative data. RESULTS The study revealed that most PPs (194 of 200; 97%) were aware of TB notification and 75% reported that they notify TB cases to the NTEP. Of those who notify, majority (129 of 145; 89%) reported that they use paper-based notification being the convenient method due to in-person visit and help by the NTEP staff. Only a third of PPs were aware of electronic notification methods. The main reasons behind low utilization of web based and mobile application were unfamiliarity and technical issues such as poor network connectivity. A third of PPs were aware about monetary incentives for notification and only 17% reported actual receipt of incentive at some point. CONCLUSIONS Our study identifies several areas where the NTEP can undertake interventions to strengthen the implementation of mandatory TB notification policy. Low awareness about electronic notification methods and preference for paper-based notification in this Study area suggest that more efforts are necessary for successful transitioning from paper-based to electronic notification system.
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Affiliation(s)
- Tushar Sahasrabudhe
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Madhusudan Barthwal
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Trupti Sawant
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Sunil Ambike
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Jayshri Jagtap
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Shashank Hande
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Sachin Atre
- Dr D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, India.
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Yu S, Sohn H, Kim HY, Kim H, Oh KH, Kim HJ, Chung H, Choi H. Evaluating the impact of the nationwide public-private mix (PPM) program for tuberculosis under National Health Insurance in South Korea: A difference in differences analysis. PLoS Med 2021; 18:e1003717. [PMID: 34260579 PMCID: PMC8318235 DOI: 10.1371/journal.pmed.1003717] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 07/28/2021] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Public-private mix (PPM) programs on tuberculosis (TB) have a critical role in engaging and integrating the private sector into the national TB control efforts in order to meet the End TB Strategy targets. South Korea's PPM program can provide important insights on the long-term impact and policy gaps in the development and expansion of PPM as a nationwide program. METHODS AND FINDINGS Healthcare is privatized in South Korea, and a majority (80.3% in 2009) of TB patients sought care in the private sector. Since 2009, South Korea has rapidly expanded its PPM program coverage under the National Health Insurance (NHI) scheme as a formal national program with dedicated PPM nurses managing TB patients in both the private and public sectors. Using the difference in differences (DID) analytic framework, we compared relative changes in TB treatment outcomes-treatment success (TS) and loss to follow-up (LTFU)-in the private and public sector between the 2009 and 2014 TB patient cohorts. Propensity score matching (PSM) using the kernel method was done to adjust for imbalances in the covariates between the 2 population cohorts. The 2009 cohort included 6,195 (63.0% male, 37.0% female; mean age: 42.1) and 27,396 (56.1% male, 43.9% female; mean age: 45.7) TB patients in the public and private sectors, respectively. The 2014 cohort included 2,803 (63.2% male, 36.8% female; mean age: 50.1) and 29,988 (56.5% male, 43.5% female; mean age: 54.7) patients. In both the private and public sectors, the proportion of patients with transfer history decreased (public: 23.8% to 21.7% and private: 20.8% to 17.6%), and bacteriological confirmed disease increased (public: 48.9% to 62.3% and private: 48.8% to 58.1%) in 2014 compared to 2009. After expanding nationwide PPM, absolute TS rates improved by 9.10% (87.5% to 93.4%) and by 13.6% (from 70.3% to 83.9%) in the public and private sectors. Relative to the public, the private saw 4.1% (95% confidence interval [CI] 2.9% to 5.3%, p-value < 0.001) and -8.7% (95% CI -9.7% to -7.7%, p-value <0.001) higher rates of improvement in TS and reduction in LTFU. Treatment outcomes did not improve in patients who experienced at least 1 transfer during their TB treatment. Study limitations include non-longitudinal nature of our original dataset, inability to assess the regional disparities, and verify PPM program's impact on TB mortality. CONCLUSIONS We found that the nationwide scale-up of the PPM program was associated with improvements in TB treatment outcomes in the private sector in South Korea. Centralized financial governance and regulatory mechanisms were integral in facilitating the integration of highly diverse South Korean private sector into the national TB control program and scaling up of the PPM intervention nationwide. However, TB care gaps continued to exist for patients who transferred at least once during their treatment. These programmatic gaps may be improved through reducing administrative hurdles and making programmatic amendments that can help facilitate management TB patients between institutions and healthcare sectors, as well as across administrative regions.
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Affiliation(s)
- Sarah Yu
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
- School of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Hojoon Sohn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hae-Young Kim
- School of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Hyunwoo Kim
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kyung-Hyun Oh
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
- End TB and Leprosy Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Hee-Jin Kim
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
| | - Haejoo Chung
- School of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Hongjo Choi
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Cheongju, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Konyang University, Daejeon, Republic of Korea
- * E-mail:
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Banu S, Haque F, Ahmed S, Sultana S, Rahman MM, Khatun R, Paul KK, Kabir S, Rahman SMM, Banu RS, Islam MS, Ross AG, Clemens JD, Stevens R, Creswell J. Social Enterprise Model (SEM) for private sector tuberculosis screening and care in Bangladesh. PLoS One 2020; 15:e0241437. [PMID: 33226990 PMCID: PMC7682881 DOI: 10.1371/journal.pone.0241437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In Bangladesh, about 80% of healthcare is provided by the private sector. Although free diagnosis and care is offered in the public sector, only half of the estimated number of people with tuberculosis are diagnosed, treated, and notified to the national program. Private sector engagement strategies often have been small scale and time limited. We evaluated a Social Enterprise Model combining external funding and income generation at three tuberculosis screening centres across the Dhaka Metropolitan Area for diagnosing and treating tuberculosis. METHODS AND FINDINGS The model established three tuberculosis screening centres across Dhaka Metropolitan Area that carried the icddr,b brand and offered free Xpert MTB/RIF tests to patients visiting the screening centres for subsidized, digital chest radiographs from April 2014 to December 2017. A network of private and public health care providers, and community recommendation was formed for patient referral. No financial incentives were offered to physicians for referrals. Revenues from radiography were used to support screening centres' operation. Tuberculosis patients could choose to receive treatment from the private or public sector. Between 2014 and 2017, 1,032 private facilities networked with 8,466 private providers were mapped within the Dhaka Metropolitan Area. 64, 031 patients with TB symptoms were referred by the private providers, public sector and community residents to the three screening centres with 80% coming from private providers. 4,270 private providers made at least one referral. Overall, 10,288 pulmonary and extra-pulmonary tuberculosis cases were detected and 7,695 were bacteriologically positive by Xpert, corresponding to 28% of the total notifications in Dhaka Metropolitan Area. CONCLUSION The model established a network of private providers who referred individuals with presumptive tuberculosis without financial incentives to icddr,b's screening centres, facilitating a quarter of total tuberculosis notifications in Dhaka Metropolitan Area. Scaling up this approach may enhance national and international tuberculosis response.
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Affiliation(s)
- Sayera Banu
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
- * E-mail:
| | - Farhana Haque
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Shahriar Ahmed
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Sonia Sultana
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Md. Mahfuzur Rahman
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Razia Khatun
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Kishor Kumar Paul
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Senjuti Kabir
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - S. M. Mazidur Rahman
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - Rupali Sisir Banu
- National Tuberculosis Control Program (NTP), Ministry of Health and Welfare, Dhaka, Bangladesh
| | - Md. Shamiul Islam
- National Tuberculosis Control Program (NTP), Ministry of Health and Welfare, Dhaka, Bangladesh
| | - Allen G. Ross
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
| | - John D. Clemens
- icddr,b (International Centre for Diarrhoeal Diseases Research Bangladesh), Dhaka, Bangladesh
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Point of Care Diagnostics in Resource-Limited Settings: A Review of the Present and Future of PoC in Its Most Needed Environment. BIOSENSORS-BASEL 2020; 10:bios10100133. [PMID: 32987809 PMCID: PMC7598644 DOI: 10.3390/bios10100133] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022]
Abstract
Point of care (PoC) diagnostics are at the focus of government initiatives, NGOs and fundamental research alike. In high-income countries, the hope is to streamline the diagnostic procedure, minimize costs and make healthcare processes more efficient and faster, which, in some cases, can be more a matter of convenience than necessity. However, in resource-limited settings such as low-income countries, PoC-diagnostics might be the only viable route, when the next laboratory is hours away. Therefore, it is especially important to focus research into novel diagnostics for these countries in order to alleviate suffering due to infectious disease. In this review, the current research describing the use of PoC diagnostics in resource-limited settings and the potential bottlenecks along the value chain that prevent their widespread application is summarized. To this end, we will look at literature that investigates different parts of the value chain, such as fundamental research and market economics, as well as actual use at healthcare providers. We aim to create an integrated picture of potential PoC barriers, from the first start of research at universities to patient treatment in the field. Results from the literature will be discussed with the aim to bring all important steps and aspects together in order to illustrate how effectively PoC is being used in low-income countries. In addition, we discuss what is needed to improve the situation further, in order to use this technology to its fullest advantage and avoid “leaks in the pipeline”, when a promising device fails to take the next step of the valorization pathway and is abandoned.
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Arsenault C, Roder-DeWan S, Kruk ME. Measuring and improving the quality of tuberculosis care: A framework and implications from the Lancet Global Health Commission. J Clin Tuberc Other Mycobact Dis 2019; 16:100112. [PMID: 31497655 PMCID: PMC6716550 DOI: 10.1016/j.jctube.2019.100112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In this article, we describe the framework of the Lancet Global Health Commission on High Quality Health Systems, propose new and undermeasured indicators of TB care quality, and discuss implications of the Commission's key conclusions for measuring and improving the quality of TB care services. The Commission contends that measurement of quality should focus on the processes of care and their impacts. In addition to monitoring treatment coverage and the availability of tools, governments should consider indicators of clinical competence (for e.g. ability of providers to correctly diagnose TB and adhere to treatment guidelines), of timely, continuous and integrated care and of respectful and patient-centered care. Indicators of impact include TB mortality and treatment success rates, but also quality of life and daily functioning among TB patients, public trust in TB services, and bypassing of the formal health system for TB care. Cascades of care, from initial care seeking to recurrence-free survival, should be built in every high-burden country to monitor quality longitudinally. In turn, improvement efforts should target the foundations of health systems and consider the Commission's four universal actions: governing for quality, redesigning service delivery, transforming the health workforce and igniting demand for quality TB services. Important work remains to validate new indicators of TB care quality, develop data collection systems for new measures, and to test new strategies for improving the delivery of competent and respectful TB care.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 1115, Boston, MA 02115, United States
| | | | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Ave., Building 1, 1115, Boston, MA 02115, United States
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Reid MJA, Goosby E. Patient-Centered Tuberculosis Programs Are Necessary to End the Epidemic. J Infect Dis 2019; 216:S673-S674. [PMID: 29117344 PMCID: PMC5853560 DOI: 10.1093/infdis/jix373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Michael J A Reid
- Division of HIV, ID and Global Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center
| | - Eric Goosby
- United Nations Secretary-General's Special Envoy on Tuberculosis, San Francisco, California
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Process evaluation of integrated early child development care at private clinics in poor urban Pakistan: a mixed methods study. BJGP Open 2017; 1:bjgpopen17X101073. [PMID: 30564679 PMCID: PMC6169929 DOI: 10.3399/bjgpopen17x101073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background In poor urban Pakistan, private GP clinics lack adequate services to promote early child development (ECD) care. A clinic-based contextualised ECD intervention was developed for quarterly tool-assisted counselling of mothers. Aim To explore the experience and implementation of ECD intervention by the private care providers and clients, for further adaptation for scaling of quality ECD care, at primary level private healthcare facilities in Pakistan. Design & setting A mixed methods approach using quantitative records review and qualitative interviews at poor urban clinics in Rawalpindi and Lahore, Pakistan. Method Quantitative data from study-specific records were reviewed for 1242 mother-child pairs registered in the intervention. A total of 18 semi-structured interviews with clinic staff, mothers, and research staff were conducted at four clinics. The interviews were audiorecorded and transcribed verbatim. Results District Health Office (DHO) support allowed transparent and effective selection and training of clinic providers. Public endorsement of ECD care at private clinics and the addition of community advocates promoted ECD care uptake. Clinic settings were found feasible for clinic assistants, and acceptable to mothers, for counselling sessions. Mothers found ECD counselling methods more engaging compared to the usual care provided. Conclusion In poor urban settings where public health care is scarce, minimal programme investment on staff training and provision of minor equipment can engage private clinics effectively in delivering ECD care.
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Albert H, Nathavitharana RR, Isaacs C, Pai M, Denkinger CM, Boehme CC. Development, roll-out and impact of Xpert MTB/RIF for tuberculosis: what lessons have we learnt and how can we do better? Eur Respir J 2016; 48:516-25. [PMID: 27418550 PMCID: PMC4967565 DOI: 10.1183/13993003.00543-2016] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/14/2016] [Indexed: 12/03/2022]
Abstract
The global roll-out of Xpert MTB/RIF (Cepheid Inc., Sunnyvale, CA, USA) has changed the diagnostic landscape of tuberculosis (TB). More than 16 million tests have been performed in 122 countries since 2011, and detection of multidrug-resistant TB has increased three- to eight-fold compared to conventional testing. The roll-out has galvanised stakeholders, from donors to civil society, and paved the way for universal drug susceptibility testing. It has attracted new product developers to TB, resulting in a robust molecular diagnostics pipeline. However, the roll-out has also highlighted gaps that have constrained scale-up and limited impact on patient outcomes. The roll-out has been hampered by high costs for under-funded programmes, unavailability of a complete solution package (notably comprehensive training, quality assurance, implementation plans, inadequate service and maintenance support) and lack of impact assessment. Insufficient focus has been afforded to effective linkage to care of diagnosed patients, and clinical impact has been blunted by weak health systems. In many countries the private sector plays a dominant role in TB control, yet this sector has limited access to subsidised pricing. In light of these lessons, we advocate for a comprehensive diagnostics implementation approach, including increased engagement of in-country stakeholders for product launch and roll-out, broader systems strengthening in preparation for new technologies, as well as quality impact data from programmatic settings. A comprehensive diagnostic solution approach including systems strengthening is essential for TB diagnostics impacthttp://ow.ly/uWSy300CfJT
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Affiliation(s)
| | - Ruvandhi R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Madhukar Pai
- Dept of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Claudia M Denkinger
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA FIND, Geneva, Switzerland
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Kulshrestha N, Nair SA, Rade K, Moitra A, Diwan P, Khaparde SD. Public-private mix for TB care in India: Concept, evolution, progress. Indian J Tuberc 2016; 62:235-8. [PMID: 26970466 DOI: 10.1016/j.ijtb.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 11/20/2015] [Indexed: 11/18/2022]
Abstract
To achieve "Universal access to TB care and treatment for all", Revised National Tuberculosis Control Programme (RNTCP) has taken steps to reach the unreached by synergizing the efforts of all partners and stakeholders. RNTCP is engaging with private sector partners in major cities of India with primary focus on notification through innovative partnership mechanisms. The manuscript details the concept behind the public-private mix for TB Care in RNTCP, its evolution and progress over the decades in India.
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Affiliation(s)
- Neeraj Kulshrestha
- Central TB Division, Directorate of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Sreenivas Achuthan Nair
- National Professional Officer - Tuberculosis, WHO Country Office for India, New Delhi, India.
| | - K Rade
- WHO Country Office for India, New Delhi, India
| | - A Moitra
- WHO Country Office for India, New Delhi, India
| | - P Diwan
- Bill and Milinda Gates Foundation, India
| | - S D Khaparde
- Central TB Division, Directorate of Health Services, Ministry of Health and Family Welfare, New Delhi, India
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Mahendradhata Y. The case for stronger regulation of private practitioners to control tuberculosis in low- and middle-income countries. BMC Res Notes 2015; 8:600. [PMID: 26499482 PMCID: PMC4619435 DOI: 10.1186/s13104-015-1586-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/14/2015] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis case management practices of private practitioners in low- and middle-income countries are commonly not in compliance with treatment guidelines, thus increasing the risk of drug resistance. National Tuberculosis control programs have long been encouraged to collaborate with private providers to improve compliance, but there is no example yet of a sustained, large scale collaborations with private practitioners in these settings. Regulations have long been realized as a potential response to poor quality care, however there has been a lack of interest from the international actors to invest in stronger regulation of private providers in these countries due to limited evidence and many implementation challenges. Regulatory strategies have now evolved beyond the costly conventional form of command and control. These new strategies need to be tested for addressing the challenge of poor quality care among private providers. Multilateral and bilateral funding agencies committed to tuberculosis control need to invest in facilitating strengthening government’s capacity to effectively regulate private providers.
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Affiliation(s)
- Yodi Mahendradhata
- Center for Health Policy and Management, Faculty of Medicine, Gadjah Mada University, Sekip Utara, Yogyakarta, 55281, Indonesia. .,Faculty of Medicine, Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
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How do private general practitioners manage tuberculosis cases? A survey in eight cities in Indonesia. BMC Res Notes 2015; 8:564. [PMID: 26468010 PMCID: PMC4607095 DOI: 10.1186/s13104-015-1560-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/05/2015] [Indexed: 12/02/2022] Open
Abstract
Background Private practitioners (PPs) in high-burden countries often provide substandard tuberculosis (TB) treatment, leading to increased risk of drug resistance and continued transmission. TB case management among PPs in Indonesia has not been investigated in recent years, despite longstanding recognition of inadequate care and substantial investment in several initiatives. This study aimed to assess case management practices of private general practitioners (GPs) in eight major cities across Indonesia. Methods A cross-sectional survey of private GPs was carried out simultaneously in eight cities by trained researchers between August and December 2011. We aimed for a sample size of 627 in total, and took a simple random sample of GPs from the validated local registers of GPs. Informed consent was obtained from participants prior to interview. Diagnostic and treatment practices were evaluated based on compliance with national guidelines. Descriptive statistics are presented. Results Of 608 eligible GPs invited to participate during the study period, 547 (89.9 %) consented and completed the interview. A low proportion of GPs (24.6–74.3 %) had heard of the International Standards
for TB care (ISTC) and only 41.2–68.9 % of these GPs had participated in ISTC training. As few as 47.3 % (90 % CI: 37.6–57.0 %) of GPs reported having seen presumptive TB. The median number of cases of presumptive TB seen per month was low (0–5). The proportion of GPs who utilized smear microscopy for diagnosing presumptive adult TB ranged from 62.3 to 84.6 %. In all cities, a substantial proportion of GPs (12.0–45.5 %) prescribed second-line anti-TB drugs for treating new adult TB cases. In nearly all cities, less than half of GPs appointed a treatment observer (13.8–52.0 %). Conclusions The pattern of TB case management practices among private GPs in Indonesia is still not in line with the guidelines, despite longstanding awareness of the issue and considerable trialing of various interventions.
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Shrestha P, Arjyal A, Caws M, Prajapati KG, Karkey A, Dongol S, Pathak S, Prajapati S, Basnyat B. The Application of GeneXpert MTB/RIF for Smear-Negative TB Diagnosis as a Fee-Paying Service at a South Asian General Hospital. Tuberc Res Treat 2015; 2015:102430. [PMID: 25949825 PMCID: PMC4407628 DOI: 10.1155/2015/102430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 02/12/2015] [Accepted: 03/18/2015] [Indexed: 11/17/2022] Open
Abstract
The GeneXpert MTB/RIF assay (Xpert) is a novel automated diagnostic tool for tuberculosis but its optimal placement in the healthcare system has not been determined. The objective of this study was to determine the possibility of additional case detection for pulmonary tuberculosis (PTB) by offering Xpert to smear-negative patients in a low-HIV burden setting with no Mycobacterium tuberculosis (M.tb.) culture facilities. Patients routinely presenting with symptoms suggestive of PTB with negative smears were offered single Xpert test on a fee-paying basis. Data were retrospectively reviewed to determine case detection in patients tested from February to December 2013. Symptoms associated with a positive test were analysed to determine if refinement of clinical criteria would reduce unnecessary testing. 258 smear-negative patients were included and M.tb. was detected in 55 (21.32%, n = 55/258). Using standard clinical assessment for selection, testing 5 patients detected one case of smear-negative PTB. These results demonstrate that fee-paying Xpert service in low-income setting can increase TB case confirmation substantially and further systematic studies of health economic implications should be conducted to determine optimal implementation models to increase access to Xpert in low- and middle-income countries.
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Affiliation(s)
- Poojan Shrestha
- Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
| | - Amit Arjyal
- Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
| | - Maxine Caws
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam
| | - Krishna Govinda Prajapati
- Department of Microbiology and Immunology, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
| | - Sabina Dongol
- Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
| | - Saruna Pathak
- Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
| | - Shanti Prajapati
- Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
| | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Hospital, Patan Academy of Health Sciences, P.O. Box 252, Kathmandu, Nepal
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Short term advantages of a public-private partnership for tuberculosis in Guinea bissau: reduction of mortality and increased diagnostic capacity. Mediterr J Hematol Infect Dis 2014; 6:e2014049. [PMID: 25045457 PMCID: PMC4103500 DOI: 10.4084/mjhid.2014.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/10/2014] [Indexed: 11/29/2022] Open
Abstract
Background Tuberculosis (TB) is widespread in Africa, but weak health systems in developing countries, often display poor quality of care with delays in case identification, irrational therapy and drug shortage, clinical mismanagement, unnecessary expenditures for patients, reduced adherence and increased mortality. Public-private partnership has demonstrated to increase TB case detection, but less is known about its effects on quality of care, mortality and costs for hospitalized TB patients. Methods Clinical outcomes and costs for TB patients at the TB National Reference Center of Bissau, in Guinea Bissau, West Africa, were determined during the first 5 months of the public-private management and compared to the ones of previous years when the hospitals was under direct Government’s management. Results 215 (2009–2010) and 194 (2012–2013) patients were admitted, respectively. Improvement (p<0.05) was observed in mortality reduction (21% vs 6%), cause of death determination (50% vs 85%), treatment abandonment (15 vs 1). Direct costs for patients during TB diagnostic pathway and inpatient care were significantly reduced, 475 vs. 0 USD. Conclusions Public-private partnerships displays significant short term benefits in National TB reference centers, even in post-conflict countries. Further studies could aid in determining the overall long term benefits of this type of cooperation, and the specific characteristic of TB and concomitant hematologic and infectious diseases in TB admitted patients.
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Pai M. Improving the quality of tuberculosis care: we need standards and strategies to translate them into practice. J Epidemiol Glob Health 2014; 4:77-80. [PMID: 24857174 PMCID: PMC7366368 DOI: 10.1016/j.jegh.2014.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/16/2014] [Indexed: 12/02/2022] Open
Affiliation(s)
- Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Canada; Department of Epidemiology & Biostatistics, McGill University, Montreal, Canada.
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Point-of-care testing for sexually transmitted infections: recent advances and implications for disease control. Curr Opin Infect Dis 2013; 26:73-9. [PMID: 23242343 DOI: 10.1097/qco.0b013e32835c21b0] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sexually transmitted infections (STIs) remain a major global public health issue, with more than 448 million incident bacterial infections each year. We review recent advances in STI point-of-care (POC) testing and implications for STI prevention and control. RECENT FINDINGS Accurate immunochromatographic assays to detect HIV, hepatitis C virus (HCV) and syphilis antibodies have made home or supervised self-testing possible. Several studies have demonstrated feasibility and excellent test characteristics for HIV, HCV and syphilis POC tests. Rapid oral HIV tests are now available for purchase at retail sites across the United States. Combined HIV and syphilis tests using a single finger prick blood sample are under evaluation. SUMMARY Oral POC STI tests with comparable performance to blood-based POC tests are available for self-testing. POC tests can expand screening, improve syndromic management and reduce loss to follow up. POC STI tests have the potential to facilitate prompt treatment and partner services. POC STI tests create opportunities for new social and financial models of community-based testing services. Increasing equity and access to testing will create challenges in linkage to care, quality assurance, partner services and surveillance. These important developments warrant research to understand appropriate contexts for implementation.
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Public–private mix in tuberculosis – Authors' reply. THE LANCET. INFECTIOUS DISEASES 2012; 12:909-10; author reply 910-1. [DOI: 10.1016/s1473-3099(12)70262-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Madhukar Pai and colleagues discuss a framework for envisioning how point-of-care testing can be applied to infectious diseases in low- and middle-income countries.
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