Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

Williams, Abimbola Onigbanjo; Makinde, Olusesan Ayodeji; Ojo, Mojisola

doi:10.1186/s41256-016-0010-y

Cited by 22 publications

(18 citation statements)

References 37 publications

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“…Bulgaria is considering a transition from hospital-based TB management to a comprehensive ambulatory TB care program. Previous studies have consistently shown that there is no significant difference in treatment outcomes between the two models of care [22, 25]. Consistent with this, in our model we simulate no parameter changes as a consequence of changing to this approach.…”

Section: Discussionsupporting

confidence: 81%

Strategic investment in tuberculosis control in the Republic of Bulgaria

et al. 2019

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As Bulgaria transitions away from Global Fund grant, robust estimates of the comparative impact of the various response strategies under consideration are needed to ensure sustained effectiveness of the tuberculosis (TB) programme. We tailored an established mathematical model for TB control to the epidemic in Bulgaria to project the likely outcomes of seven intervention scenarios. Under existing programmatic conditions projected forward, the country's targets for achieving TB elimination in the coming decades will not be achieved. No interventions under consideration were predicted to accelerate the baseline projected reduction in epidemiological indicators significantly. Discontinuation of the ‘Open Doors’ program and activities of non-governmental organisations would result in a marked exacerbation of the epidemic (increasing incidence in 2035 by 6–8% relative to baseline conditions projected forward). Changing to a short course regimen for multidrug-resistant TB (MDR-TB) would substantially decrease MDR-TB mortality (by 21.6% in 2035 relative to baseline conditions projected forward). Changing to ambulatory care for eligible patients would not affect TB burden but would be markedly cost-saving. In conclusion, Bulgaria faces important challenges in transitioning to a primarily domestically-financed TB programme. The country should consider maintaining currently effective programs and shifting towards ambulatory care to ensure program sustainability.

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Section: Discussionsupporting

confidence: 81%

Strategic investment in tuberculosis control in the Republic of Bulgaria

et al. 2019

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“…Community-based treatment models allow a patient to complete treatment in their own homes, under the supervision of a close contact. This incurs fewer transportation costs to the patients, and in some cases provides better home care and improved social wellbeing as well as an improved ability to continue with daily activities [45][46][47][48]. Speci cally, rural community-based models have been shown to be more effective than urban community-based models, in part due to the organized referral system in rural settings and perhaps due to the increased advantages of not traveling to a distant clinic for care [29].…”

Section: Discussionmentioning

confidence: 99%

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Monje¹,

Kadobera²,

Owolabi³

et al. 2021

Preprint

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Background: Childhood tuberculosis (TB) remains a major public health problem in Uganda. Failure to complete TB treatment is associated with development of multi-drug-resistant TB, continued spread of TB, and death. The World Health Organization (WHO) recommends treatment success rates of ≥85% to achieve TB control, but children often have lower success rates due to challenges in case identification and treatment adherence. We assessed trends in childhood TB case notification rates, spatial case distribution, treatment outcomes, and predictors of treatment completion at Mbale Regional Referral Hospital (MRRH) in Eastern Uganda.Methods: We reviewed TB registers and extracted data for patients aged 0-14 years with presumptive TB at MRRH for 2013-2017. We determined the childhood TB case notification rate in the MRRH catchment area, performed a TB case notification rate trend analysis and described spatial TB case distribution. We used logistic regression to identify patient-related and hospital-related factors associated with completion of TB treatment at MRRH among HIV-positive and HIV-negative patients. Results: We identified 331 TB case notifications among children <15 years. TB case notification rates declined from 6.6/100,000 in 2013 to 2.2/100,000 in 2017 [odds ratio (OR)=0.81; 95% confidence intervals (CI)=0.58-1.1]. Mbale District recorded the highest TB case notification rate (79/100,000), and Kapchorwa District recorded the lowest TB case notification rate (3.8/100,000). Completion rates varied from 35% to 80%. Of the 331 patients, 167 (50%) completed TB treatment. In logistic regression, 142 (75%) of 189 HIV-negative TB patients completed TB treatment compared to 25 (54%) of 46 HIV-positive TB patients (OR=2.5; 95%CI=1.3-4.9). Seventy-four (63%) of 117 patients in the facility-based model and 93 (79%) of patients in the community-based model completed TB treatment (OR=0.47; 95% CI=0.26-0.83).Conclusions: Only half of childhood TB patients completed treatment, well below the WHO target of ≥85% completion. Although TB completion was associated with treatment model and HIV-negative status, neither HIV-positive nor HIV-negative patients had acceptable completion rates. MRRH should strengthen HIV treatment services among childhood TB patients by engaging peer groups and trusted community leaders to provide education on the importance of completing TB treatment.

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“…Community-based DOT (CB-DOT), designed to relieve the pressure of patient care on overstretched health facilities in countries with a high TB burden [24], is a cost-effective approach associated with better compliance to treatment and better patient satisfaction compared to hospital-based DOT (HB-DOT) [25]. Systematic review [26–28] also showed that CB-DOT did improve TB treatment outcomes. In China, TPM by LHWs in the integrated TB control model [6] is one type of CB-DOT.…”

Section: Discussionmentioning

confidence: 99%

Is tuberculosis patients management improved in the integrated TB control model in West China? A survey in Guizhou Province, China

Wei²,

Jiang

et al. 2019

Infect Dis Poverty

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Background Tuberculosis (TB) patient management (TPM) is crucial to improve patient compliance to treatment. The coverage of TPM delivered by TB dispensaries or Centers for Disease Control and Prevention (CDC) was not high under the previous CDC model of TB control in China. In the integrated TB control model in China, TB patient management (TPM) was mainly delivered by lay health workers (LHWs) in primary health care (PHC) sectors. This study aims to investigate TPM delivery in resource-limited western China and to identify factors affecting TPM delivery by LHWs under the integrated TB control model. Methods A stratified random sampling was used to select study sites. Pulmonary TB (PTB) patients ≥15 years old from selected counties/districts in Guizhou Province were surveyed from August 2015 to May 2016. Structured questionnaires were used to collect data. A χ 2 test and logistic regression were used to identify factors associated with self-administered treatment (non-TPM). Results In total, 638 PTB patients were included in the final analysis. Close to 30% of patients were ethnic minorities. More than 30% of patients were from counties with high TB burden, and 24.9% of patients had poor compliance to treatment. Only 37.1% of patients received TPM delivered by LHWs under the integrated TB control model throughout the treatment period. The main reasons for unwillingness to manage reported by patients included social stigma and no perceived need. Being ethnic minorities ( OR = 3.35) was a main factor associated with lower likelihood of receiving TPM, while living in areas with middle or high TB burden may increase the likelihood of receiving TPM ( OR = 0.17 and 0.25, respectively). Among current management approaches, more than 85% of patients chose phone reminder as their preferred TPM by LHWs. Conclusions TPM under the integrated model in West China is still low and need further improvement, and the impeding factors of TPM need to be addressed. Strengthening patient-centered and community-based TPM and developing more feasible approaches of TPM delivery should be explored in future research in this region. Electronic supplementary material The online version of this article (10.1186/s40249-019-0563-3) contains supplementary material, which is available to authorized users.

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Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

Cited by 22 publications

References 37 publications

Strategic investment in tuberculosis control in the Republic of Bulgaria

Strategic investment in tuberculosis control in the Republic of Bulgaria

Trends and Treatment Outcomes of Pediatric Tuberculosis at Mbale Regional Referral Hospital, in Eastern Uganda, 2013-2017

Is tuberculosis patients management improved in the integrated TB control model in West China? A survey in Guizhou Province, China

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