Magnitude and Reasons for Gaps in Tuberculosis Diagnostic Testing and Treatment Initiation: An Operational Research Study from Dakshina Kannada, South India

Ismail, Imaad Mohammed; Madhukeshwar, Akshaya Kibballi; Naik, Poonam Ramesh; Nayarmoole, Badarudeen Mohammad; Satyanarayana, Srinath

doi:10.2991/jegh.k.200516.001

Cited by 7 publications

(21 citation statements)

References 8 publications

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“…In 1 study, patients whose families preferred private sector (rather than public sector) health services had higher adjusted odds of PTLFU [66]. Similarly, patients who were initially evaluated at private sector labs or facilities (as compared to public primary health centers) had higher adjusted PTLFU risk [42].…”

Section: Factors Associated With Non-completion Of Sputum Microscopy ...mentioning

confidence: 90%

“…c Of these 15 studies, 3 reported on non-pursual of diagnostic workup despite referral [40][41][42], 4 reported on non-completion of sputum microscopy evaluation [43][44][45][46], 2 reported on chest X-ray non-completion [47,48], and 6 reported on non-completion of NAAT, line probe assay, or mycobacterial culture [47,[49][50][51][52][53].…”

Section: Characteristics and Quality Of The Included Studiesmentioning

confidence: 99%

“…Patients who traveled more than 10 kilometers in 1 unadjusted analysis [46]-or who lived in rural areas but sought medical evaluation in cities in 1 adjusted and 1 unadjusted analysis [64,72]-had higher PTLFU risk. 2 studies found patients with a previous TB history had higher adjusted PTLFU risk [42,64]. 0 Health system-related factors were also associated with PTLFU.…”

Section: Factors Associated With Non-completion Of Sputum Microscopy ...mentioning

confidence: 99%

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Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

Jhaveri,

Galivanche

et al. 2023

Preprint

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Background. India has the highest burden of tuberculosis (TB), accounting for more than one-quarter of people with active TB and nearly one-third of TB deaths globally. Most people contracting active TB in India do not successfully navigate all stages of the care cascade to receive treatment and achieve TB recurrence-free survival. Understanding reasons for losses across the care cascade is critical to improve outcomes. In this paper, guided by a PECO (population/exposure/comparison/outcome) framework, we describe quantitative findings of a systematic review aimed at identifying factors contributing to unfavorable outcomes experienced by people with TB at each care cascade gap in India. Methods and findings. We defined care cascade gaps as comprising people with confirmed or presumptive TB who did not: start the TB diagnostic workup (Gap 1), complete the diagnostic workup (Gap 2), start treatment (Gap 3), achieve treatment success (Gap 4), or achieve TB recurrence-free survival (Gap 5). Three systematic searches were conducted to identify 147 unique articles published from 2000 to 2021 that evaluated factors associated with unfavorable outcomes for each gap (reported as odds, relative risk, or hazard ratios) and, among people experiencing unfavorable outcomes, reasons reported for these outcomes (reported as proportions). Findings were organized into patient-, family-, society-, or health system-related factors, using a social-ecological framework. Some factors were common and associated with unfavorable outcomes across multiple care cascade stages. These included male sex, older age (variably defined across studies), a broad array of poverty-related factors, lower symptom severity or duration, undernutrition, alcohol use, smoking, and distrust of (or dissatisfaction with) local government health services. People who had been previously treated for TB were more likely to seek care and engage in the TB diagnostic workup (Gaps 1 and 2) but were also more likely to suffer pretreatment loss to follow-up (Gap 3) and unfavorable outcomes during TB treatment (Gap 4), especially those who had been lost to follow-up during their prior treatment episode. For individual care cascade gaps, multiple studies highlighted the importance of lack of TB knowledge and structural barriers to care (e.g., transport or financial challenges in reaching clinics) in contributing to lack of care-seeking for TB symptoms (Gap 1, 15 studies or analyses); lack of access to diagnostics (e.g., chest X-ray), non-identification of eligible patients for testing, and failure of providers to communicate concern for TB to patients in contributing to non-completion of the diagnostic workup (Gap 2, 20 studies or analyses); TB stigma, poor recording of patient contact information by providers, and early death due to diagnostic delays in contributing to pretreatment loss to follow-up (Gap 3, 25 studies); and medication adverse effects, TB stigma, and lack of TB knowledge in contributing to unfavorable treatment outcomes (Gap 4, 104 studies). Medication nonadherence contributed to unfavorable treatment outcomes (Gap 4) and post-treatment TB recurrence (Gap 5, 15 studies). Conclusions. This extensive systematic review illuminates common patterns of risk that shape outcomes for people with TB in India, while also highlighting gaps in knowledge, particularly with regard to TB care for children or in the private sector, that can help to guide future research. These findings may help inform targeting of additional support services to people with TB who are at higher risk of poor outcomes and inform development of multi-component interventions to close gaps in India′s TB care cascade.

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Section: Factors Associated With Non-completion Of Sputum Microscopy ...mentioning

confidence: 90%

Section: Characteristics and Quality Of The Included Studiesmentioning

confidence: 99%

Section: Factors Associated With Non-completion Of Sputum Microscopy ...mentioning

confidence: 99%

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Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

Jhaveri,

Galivanche

et al. 2023

Preprint

Self Cite

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“…TB diagnosis and treatment parameters were obtained from the prospective study [ 6 ] and 2018 Indus Health Network TB clinic data. The annual mortality rate from untreated TB was assumed to be 39% for smear-positive and 2.5% for smear-negative TB patients [ 13 , 15 , 16 ]. The annual rate of spontaneous resolution of untreated TB was assumed to be 23% for smear-positive and 13% for smear-negative TB patients [ 13 , 15 , 16 ].…”

Section: Methodsmentioning

confidence: 99%

Triage of Persons With Tuberculosis Symptoms Using Artificial Intelligence–Based Chest Radiograph Interpretation: A Cost-Effectiveness Analysis

Nsengiyumva

Hussain²,

Oxlade

et al. 2021

Open Forum Infectious Diseases

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Background In settings without access to rapid expert radiographic interpretation, artificial intelligence (AI)–based chest radiograph (CXR) analysis can triage persons presenting with possible tuberculosis (TB) symptoms, to identify those who require additional microbiological testing. However, there is limited evidence of the cost-effectiveness of this technology as a triage tool. Methods A decision analysis model was developed to evaluate the cost-effectiveness of triage strategies with AI-based CXR analysis for patients presenting with symptoms suggestive of pulmonary TB in Karachi, Pakistan. These strategies were compared to the current standard of care using microbiological testing with smear microscopy or GeneXpert, without prior triage. Positive triage CXRs were considered to improve referral success for microbiologic testing, from 91% to 100% for eligible persons. Software diagnostic accuracy was based on a prospective field study in Karachi. Other inputs were obtained from the Pakistan TB Program. The analysis was conducted from the healthcare provider perspective, and costs were expressed in 2020 US dollars. Results Compared to upfront smear microscopy for all persons with presumptive TB, triage strategies with AI-based CXR analysis were projected to lower costs by 19%, from $23233 per 1000 persons, and avert 3%–4% disability-adjusted life-years (DALYs), from 372 DALYs. Compared to upfront GeneXpert, AI-based triage strategies lowered projected costs by 37%, from $34346 and averted 4% additional DALYs, from 369 DALYs. Reinforced follow-up for persons with positive triage CXRs but negative microbiologic tests was particularly cost-effective. Conclusions In lower-resource settings, the addition of AI-based CXR triage before microbiologic testing for persons with possible TB symptoms can reduce costs, avert additional DALYs, and improve TB detection.

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“…Furthermore, gaps in diagnostic testing occurred for COVID-19, possibly due to mobility restrictions, lockdowns, a lack of healthcare workers, insufficient awareness regarding TB diagnostic tests, and insufficient infrastructure. Involvement of private healthcare institutions in TB control (12). In order to close these gaps in the care cascade, interventions might be required at the population or health system levels, the TB diagnostic and treatment facilities, and the patient-health provider level.…”

Section: Covid-19 and Diagnostic Delaysmentioning

confidence: 99%

Integrating Indian Post and National Tuberculosis Elimination Program - A new way ahead

Garg¹,

Panwar²,

Sharma³

et al. 2021

Journal of Comprehensive Health

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COVID-19 and its response have a significant influence on healthcare services throughout the world and are likely to put the National Tuberculosis Elimination Program (NTEP) under immense pressure. Mitigation actions taken by the government to prevent the spread of infection have led to missed diagnoses and a halt in services such as active case finding, contact tracing, and follow-ups. Diagnostic delays have created a gap in the TB care chain, increasing mortality rates and morbidity, and can worsen the disease burden in marginalized communities. Closing these gaps requires intervention at the population and government levels. Integrating the Indian Post with the National Tuberculosis Elimination Program will be a milestone in the specimen transport system and will ultimately result in better diagnosis and treatment of Tuberculosis.

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Magnitude and Reasons for Gaps in Tuberculosis Diagnostic Testing and Treatment Initiation: An Operational Research Study from Dakshina Kannada, South India

Cited by 7 publications

References 8 publications

Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

Triage of Persons With Tuberculosis Symptoms Using Artificial Intelligence–Based Chest Radiograph Interpretation: A Cost-Effectiveness Analysis

Integrating Indian Post and National Tuberculosis Elimination Program - A new way ahead

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