The experience of scaling up a decentralized, ambulatory model of care for management of multidrug-resistant tuberculosis in two regions of Ethiopia

Abstract

Strong strategies, including proven service delivery models, are needed to address the growing global threat of multidrug-resistant tuberculosis (MDR-TB) in low- and middle-income settings. The objective of this study was to assess the feasibility and effectiveness of the nationally approved ambulatory service delivery model for MDR-TB treatment in two regions of Ethiopia. We used routinely reported data to describe the process and outcomes of implementing an ambulatory model for MDR-TB services in a resource-limited setting. We compared percentage improvements in the number of MDR-TB diagnostic and treatment facilities, number of MDR-TB sputum samples processed per year, and MDR-TB cases ever enrolled in care between baseline and 2015. We also calculated interim and final treatment outcomes for patients who had completed at least 12 and 24 months of follow-up, respectively. Between 2012 and 2015, the number of MDR-TB treatment-initiating centers increased from 1 to 23. The number of sputum samples tested for MDR-TB increased 20-fold, from 662 to 14,361 per year. The backlog of patients on waiting lists was cleared. The cumulative number of MDR-TB patients put on treatment increased from 56 to 790, and the treatment success rate was 75%. Rapid expansion of the ambulatory model of MDR-TB care was feasible and achieved a high treatment success rate in two regions of Ethiopia. More effort is needed to sustain the gains and further decentralize services to the community level.

Lost to follow-up and associated factors among patients with drug resistant tuberculosis in Ethiopia: A systematic review and meta-analysis

“…From the twelve selected studies for qualitative synthesis, 9 studies were retrospective cohort [26][27][28][29][30][31][32][33][34], 2 cross sectionals [35,36] and 1 prospective cohort study [37]. The publication year range from 2014 to 2020.…”

What will it take to eliminate drug-resistant tuberculosis?

“…In a recent survey of 29 high-TB-burden countries, use of the 9–12 month treatment regimen, bedaquiline, and delamanid were included in the policies of 45% (13), 79% (23), and 62% (18), respectively. 18 Compulsory hospitalization at the start of MDR-TB treatment, which can restrict treatment access and delay treatment initiation, 19,20 was still required by 9 (31%) surveyed countries. 18 Despite success rates above 80% for standard MDR-TB treatment in recent clinical trials 21 and some national programs, 22 the latest global treatment success rate for MDR-TB is 54%.…”

“…district and sub-district) levels of the health system. Decentralizing treatment and removing reliance on inpatient admission can improve access, reduce delays, and make treatment more patient-centered, 19,51,52 and has proven feasible across different contexts and countries. 19,51,53,54 To enable this, TB programs will need to routinely implement quality improvement strategies.…”

Factors influencing the length of hospital stay during the intensive phase of multidrug-resistant tuberculosis treatment at Amhara regional state hospitals, Ethiopia: a retrospective follow up study

“…The median length of hospital stay also explored over time, and differences observed from a median of 94 days in 2012 to 60 days in 2015. The possible explanations might be better patient management experience in the later time, the use of new treatment approaches, and early case detection through active surveillance before critical conditions happened might contribute to cutting LOS [30].…”