Patient-Pathway Analysis of Tuberculosis Services in Cameroon

Titahong, Collins N.; Ayongwa, Gideon N.; Waindim, Yvonne; Nguafack, Dubliss; Kuate, Albert Kuate; Wandji, Irene Adeline Goupeyou; Wringe, Alison; Mbassa, Vincent; Sander, Melissa; Mitchell, Ellen M. H.

doi:10.3390/tropicalmed6040171

Cited by 7 publications

(2 citation statements)

References 17 publications

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“…Of the 150 NTP testing sites in the intervention area, 117 were included in the intervention activities, with preference given to sites with high attendance rates and accessibility; the other 33 TB treatment and diagnostic sites were not included in the activities due to site-specific issues such as low consultation rates, location, and in some cases due to insecurity in the area. Primary care sites were selected from among the more than 3,000 primary care (Level 1) centers in the intervention area [14,28]. We aimed to link approximately 5 primary care sites to each TB testing site.…”

Section: Case Detection Interventionmentioning

confidence: 99%

“…There are several potential contributors to the low levels of TB treatment coverage. A patient pathway analysis of TB services [12,13] performed using 2018 data estimated that only a small percentage (3-16%) of people have access to TB diagnostic and treatment services at initial care seeking; instead most people seek care either at primary care facilities without diagnostic services or through the informal private sector [14]. Additional factors potentially contributing to the low treatment coverage were the 1,000 CFA (approx.…”

Section: Introductionmentioning

confidence: 99%

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Impact of intensified tuberculosis case finding at health facilities on case notifications in Cameroon: A controlled interrupted time series analysis

Mana

Beaudou

Hilaire

et al. 2022

PLOS Glob Public Health

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There is a large gap between the number of people who develop tuberculosis (TB) and those who are diagnosed, treated and notified, with only an estimated 71% of people with TB notified globally in 2019. Implementing better TB case finding strategies is necessary to close this gap. In Cameroon, 1,597 healthcare workers at 725 health facilities were trained and engaged to intensively screen and test people for TB, then follow-up to link people to appropriate care. Primary care centers were linked to TB testing through a locally-tailored specimen referral network. This intervention was implemented across 6 regions of the country, with a population of 16 million people, while the remaining 4 regions in the country, with 7.3 million people, served as a control area. Controlled interrupted time series analyses were used to compare routinely-collected programmatic TB case notification rates in the intervention versus control area for 12 quarters prior to (2016–2018) and for 8 quarters after the start of the intervention (2019–2020). In 2019–2020, a total of 167,508 people were tested for TB at intervention sites, including 52,980 people attending primary care facilities that did not previously provide organized TB services. The number of people tested for TB increased by 45% during the intervention as compared to prior to the intervention. The controlled interrupted time series analyses showed that after two years of the intervention, the all-forms TB case notification rate in the intervention population increased by 9% (ratio of case notification rate ratios = 1.09, 95% CI 1.06 to 1.12), as compared with the counterfactual estimated from pre-intervention trends. This increase was observed even during a negative national impact on case finding from the COVID-19 pandemic. These results support the use of this health-facility based intervention to improve access to TB testing and care in this setting.

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Section: Case Detection Interventionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of intensified tuberculosis case finding at health facilities on case notifications in Cameroon: A controlled interrupted time series analysis

Mana

Beaudou

Hilaire

et al. 2022

PLOS Glob Public Health

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Evaluating the health impact, health-system costs and cost-effectiveness of using TrueNat on stool samples compared to usual care for the diagnosis of paediatric tuberculosis in primary care settings: a modelling analysis

Mafirakureva,

Daniel,

Olayinka

et al. 2024

Preprint

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The World Health Organisation (WHO) recommends rapid molecular diagnostics to improve bacteriological confirmation of tuberculosis in children. TrueNat MTB, MTB Plus and MTB-RIF Dx assays (Molbio Diagnostics, India), recommended by WHO, hold potential as point-of-care tests in resource-limited settings. Using stool samples with these assays could enhance testing access, improve linkage to care, reduce costs, and increase cost-effectiveness over traditional methods. However, evidence on their costs and cost-effectiveness is limited and needed for informed policy decisions on adoption and scale up. We used a decision-tree analytic modelling approach, time-and-motion study, and routine data to estimate the potential impact of implementing stool-based TrueNat testing for the diagnosis of pulmonary tuberculosis in children within Nigerian primary healthcare settings on healthcare outcomes, resource use, health system costs, and cost-effectiveness relative to the standard of care (SoC). The cost per test was $13.06 (standard deviation; $0.77) for TrueNat and $16.25 (standard deviation; $1.34) for Xpert. For every 100 children with presumptive tuberculosis, the stool-based TrueNat testing intervention was projected to increase case detection rate by 29% (95% uncertainty interval [UI 9-48]) and bacteriological confirmation by 6% (95% UI 3-8). Diagnoses at primary health centres (PHC) would increase by 34% (95% UI 20-46), averting 7 (95% UI 2-12) deaths and 182 (95% UI 59-311) discounted DALYs. Although resource use and health system costs increased by $6,172 (95% UI -2,427-10,455) per 100 children, the incremental cost-effectiveness ratio of $34 per DALY averted suggests cost-effectiveness at thresholds of 0.5×GDP per capita. Implementing stool-based TrueNat testing has potential to increase access and reduce direct health system costs associated with the diagnosis of pulmonary tuberculosis in children in routine health care settings. Such an approach is likely to represent a good value for money compared to SoC.

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‘We did not even know it was tuberculosis’: a qualitative evaluation of integrating tuberculosis services into paediatric entry points in the CaP-TB programme in Cameroon and Kenya

Katirayi,

Masaba,

Tchounga

et al. 2024

bmjph

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Introduction Paediatric tuberculosis (TB) is often undiagnosed and under-reported. The Catalysing Paediatric TB (CaP-TB) programme provided integrated and decentralised TB screening and diagnosis services through multiple paediatric care entry points. This qualitative evaluation explores acceptability of the CaP-TB programme and existing knowledge and perceptions of paediatric TB. Methods A descriptive qualitative study was conducted in four sites in Kenya and six sites in Cameron. 54 in-depth interviews were conducted with caregivers, community workers (CWs) and CaP-TB programme managers, and 7 focus group discussions with healthcare workers (HCWs) and CWs. Thematic analysis identified emerging recurrent themes across participants’ responses. Data were coded by using MAXQDA V.12. Data were collected during March–September 2021. Results Caregivers were often not aware that children were at risk for TB. HCWs reported limited knowledge about paediatric TB prior to CaP-TB. Sometimes caregivers refused to have their children tested for paediatric TB, and this was often related to a lack of awareness of paediatric TB and free services, concerns about the testing procedure and treatment and fear of stigma. TB was referred to as disease of ‘shame,’ associated with poverty and poor hygiene. The CaP-TB programme increased HCWs knowledge about symptoms of paediatric TB and motivation to investigate children with clinical presentations consistent with possible TB. Adding screening at all entry points was perceived to be beneficial to caregivers who would not have felt comfortable bringing their child to a TB unit. HCWs also discussed the increased workload with CaP-TB, challenges with medication stock-outs and a need for additional training. Conclusions CaP-TB illustrated the positive impact of decentralised paediatric TB services, including addressing the awareness and knowledge gap among caregivers and HCWs. Multiple entry points increased opportunities for identification of paediatric TB and increased caregiver comfortability with their child being tested for TB. Trial registration number NCT03862261 .

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Patient-Pathway Analysis of Tuberculosis Services in Cameroon

Cited by 7 publications

References 17 publications

Impact of intensified tuberculosis case finding at health facilities on case notifications in Cameroon: A controlled interrupted time series analysis

Impact of intensified tuberculosis case finding at health facilities on case notifications in Cameroon: A controlled interrupted time series analysis

Evaluating the health impact, health-system costs and cost-effectiveness of using TrueNat on stool samples compared to usual care for the diagnosis of paediatric tuberculosis in primary care settings: a modelling analysis

‘We did not even know it was tuberculosis’: a qualitative evaluation of integrating tuberculosis services into paediatric entry points in the CaP-TB programme in Cameroon and Kenya

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