Rates and timeliness of treatment initiation among drug-resistant tuberculosis patients in Nigeria- A retrospective cohort study

Tseja-Akinrin²,

Sen

et al. 2020

BMJ Glob Health

Self Cite

BackgroundDrug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care.MethodsUsing an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019).ResultsOf 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms.ConclusionCase detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.

Section: Recommendationsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

Tseja-Akinrin²,

Sen

et al. 2020

BMJ Glob Health

Self Cite

“…We used a transformative study design using key informant interview, focus group interviews, and document review. This is part of a larger mixed methods study, with previously published quantitative results (31). In this paper, we report on the qualitative portion of the data.…”

Section: Methodsmentioning

confidence: 96%

“…We reviewed several National TB and Leprosy Control Program (NTBLCP) and Federal Ministry of Health (FMOH) policy and guideline (44)(45)(46) documents including the workers' manual (47) and the 2015 annual TB program report (9), some unpublished program data (48)(49)(50) and WHO country pro le (1). This is part of a larger mixed methods study, with previously published quantitative results (31) and mixed methods results (51). We analysed data from 57 interviews.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes

Bada

Agbaje

et al. 2020

Preprint

Self Cite

Introduction: Persistent low rates of case notification and treatment coverage reflect that accessing free diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic characteristics. Our study analyzed elements that facilitate or hinder equitable access for different groups of patients within the current health system to support DR-TB management in Nigeria. Methods: We conducted documentary review of guidelines and workers manuals, as well as 29 qualitative interviews, including 5 focus group discussions, with a total of 62 participants, in Nigeria. Between August and November 2017, we conducted qualitative interviews of patients who were on treatment, their treatment supporter, and providers in Ogun and Plateau States, as well as program managers in Benue and Abuja. We adapted and used Levesque’s patient-centered access to care framework to analyze DR-TB policy documents and interview data. Results: Thematic analysis revealed inequitable access to DR-TB care for some patient socio-demographic groups. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Health system factors including positive provider attitudes and financial support provided to the patients facilitated equity and ease of access. However, limited coverage and the absence of patients’ access rights protection and considerations in the treatment guidelines and workers manuals likely hampered access. Conclusion: In the context of Nigeria’s low case-finding and treatment coverage, applying an equity of access framework was necessary to highlight gaps in care. Differing social contexts of patients adversely affected their access to DR-TB care. We identified several strengths in DR-TB care delivery, including the current financial support that should be sustained. Our findings highlight the need for government’s commitment and continued interventions.

“…These included the TB HIV treatment guideline, workers' manuals, annual TB reports and WHO country pro les. This is part of a larger mixed methods study, with previously published quantitative results (31). We analysed data from 29 out of the 57 interviews conducted as part of the larger study.…”

Section: Study Population and Data Collectionmentioning

confidence: 99%

Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes

Bada

Agbaje

et al. 2020

Preprint

Self Cite

Abstract Introduction: Persistent low rates of case notification and treatment coverage reflect that accessing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge, even though it is provided free of charge to patients. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic characteristics. Our study analyzed elements that facilitate or hinder equitable access for different groups of patients within the current health system to support DR-TB management in Nigeria. Methods: We conducted documentary review of guidelines and workers manuals, as well as 29 qualitative interviews, including 5 focus group discussions, with a total of 86 participants, in Nigeria. Between August and November 2017, we interviewed patients who were on treatment, their treatment supporter, and providers in Ogun and Plateau States, as well as program managers in Benue and Abuja. We adapted and used Levesque’s patient-centered access to care framework to analyze DR-TB policy documents and interview data. Results: Thematic analysis revealed inequitable access to DR-TB care for some patient socio-demographic groups. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Health system factors including positive provider attitudes and financial support provided to the patients facilitated equity and ease of access. However, limited coverage and the absence of patients’ access rights protection and considerations in the treatment guidelines and workers manuals likely hampered access. Conclusion: In the context of Nigeria’s low case-finding and treatment coverage, applying an equity of access framework was necessary to highlight gaps in care. Differing social contexts of patients adversely affected their access to DR-TB care. We identified several strengths in DR-TB care delivery, including the current financial support that should be sustained. Our findings highlight the need for government’s commitment and continued interventions.