Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012–2013 outcomes

Abstract

Background: We aimed to identify challenges and to propose solutions for the implementation of tuberculosis (TB) programmes in rural Sub-Saharan Africa (SSA) by evaluating the outcomes of the TB programme in the Ancuabe district in rural Northern Mozambique. Methods: Retrospective descriptive study of the patients included in the TB programme in 2012-2013. Follow-up was continued till June 2014. Results: Three hundred nineteen patients were registered, 62.1% male, mean age 36.3 (SD 14.4), estimated case detection rate (eCDR) of 24.24%. Two hundred seventy-two were new cases, 21 transferred-in, 11 back after lost to follow-up (LTFU), 10 relapsing TB, 5 previous treatment failures. 94.4% were tested for Human immunodeficiency virus (HIV), 41.9% HIV-positive. 87.5% of the new cases were pulmonary TB (PTB), 43.4% were HIV co-infected. Initial sputum results were available in 207 cases, with 145 smear-positive (SP) cases. Outcomes of new cases: 122 (44.9%) LTFU, 55 (20.2%) cured, 43 (15.8%) treatment completed (98-36%-treatment success), 31 (11.4%) died, 19 (7%) transferred out and 2 (0.7%) failures. Conclusions: A low eCDR and high proportion of LTFU demonstrate that few patients were identified and had a low probability of complete treatment, suggesting a fragile health system. This raises the hypothesis that, probably, to improve TB health care in rural SSA, interventions should aim at improving health systems. Special attention should be given to social protection and compensation of the financial burden associated with TB.

Discursos sobre a terapia de curta duração para o controle da tuberculose

“…This strategy has proved effective in curing TB. It is noteworthy that between the years 1995 and 2012, when 56 million people were treated and cured in countries that adopted the DOTS strategy, 22 million lives were saved (1,4) .…”

“…When implemented, the DOTS strategy is effective; however, in Mozambique, the coverage of this policy reaches only 50% of the population diagnosed with TB. Complementing this context, some studies indicate barriers to the DOTS implementation, such as the lack of human, material and financial resources, in addition to the HIV pandemic, which influence disease control (3)(4) . In this sense, there are no studies that discursively explore the perceptions and experiences of healthcare professionals involved in the DOTS implementation.…”

“…Currently, Mozambique remains among the countries that, according to the WHO, cannot reduce TB incidence, prevalence and mortality rates. Estimated new cases are around 140,000 per year, of which only 50% begin medical treatment, corresponding to an annual growth rate of 9%, and a prevalence of 556/100,000 inhabitants (1,(3)(4) . When implemented, the DOTS strategy is effective; however, in Mozambique, the coverage of this policy reaches only 50% of the population diagnosed with TB.…”

“…Mozambique began using the DOTS strategy even before it was proposed by the World Health Organization (WHO) through the TB control program, with the support of the International Union Against Tuberculosis and Lung Disease (IUATLD), which assisted the country in the DOTS implementation in the 1980s (2)(3)(4) . Currently, Mozambique remains among the countries that, according to the WHO, cannot reduce TB incidence, prevalence and mortality rates.…”

“…In its guidelines, DOTS advocates the detection of TB cases, directly observed treatment (DOT), regular medicine provision, case registration system, and government commitment, placing TB control as a priority among health policies (1,(3)(4) . This strategy has proved effective in curing TB.…”