Using hospital auxiliary worker and 24-h TB services as potential tools to overcome in-hospital TB delays: a quasi-experimental study

Abstract

Background: In-hospital logistic management barriers (LMB) are considered to be important risk factors for delays in TB diagnosis and treatment initiation (TB-dt), which perpetuates TB transmission and the development of TB morbidity and mortality. We assessed the contribution of hospital auxiliary workers (HAWs) and 24-h TB laboratory services using Xpert (24h-Xpert) on the delays in TB-dt and TB mortality at Beira Central Hospital, Mozambique. Methods: A quasi-experimental design was used. Implementation strategy-HAWs and laboratory technicians were selected and trained, accordingly. Interventions-having trained HAW and TB laboratory technicians as expediters of TB LMB issues and assurer of 24h-Xpert, respectively. Implementation outcomes-time from hospital admission to sputum examination results, time from hospital admission to treatment initiation, proportion of same-day TB cases diagnosed, initiated TB treatment, and TB patient with unfavorable outcome after hospitalization (hospital TB mortality). A nonparametric test was used to test the differences between groups and adjusted OR (95% CI) were computed using multivariate logistic regression. Results: We recruited 522 TB patients. Median (IQR) age was 34 (16) years, and 52% were from intervention site, 58% males, 60% new case of TB, 12% MDR-TB, 72% TB/HIV co-infected, and 43% on HIV treatment at admission. In the intervention hospital, 93% of patients had same-day TB-dt in comparison with a median (IQR) time of 15 (2) days in the control hospital. TB mortality in the intervention hospital was lower than that in the control hospital (13% vs 49%). TB patients admitted to the intervention hospital were nine times more likely to obtain an early laboratory diagnosis of TB, six times more likely to reduce delays in TB treatment initiation, and eight times less likely to die, when compared to those who were admitted to the control hospital, adjusting for other factors.

Person-centered strategies for delivering TB diagnostic services in Lima, Peru

“… 7 Programs to expedite TB evaluations among people who are hospitalized have been shown to improve TB detection and reduce delays to diagnosis. 17 , 18 In general outpatient settings, offering expedited attention to people with respiratory symptoms without compromising the timeliness of care for people without symptoms would require adding additional providers who are trained in diagnosing respiratory conditions.…”

Improving cascade outcomes for active TB: A global systematic review and meta-analysis of TB interventions

“…The variations in settings (rural communities versus urban slums) and target populations (general populations versus prisoners or ex-convicts) and approach to implementation for each intervention contributed to heterogeneity. For example, a study adapted "staff training + recruited and trained lay workers + active case finding" as a comprehensive care approach, while another study implemented "peer training + patient counseling and education +onsite sputum collection + expediated treatment initiation" to improve case detection and treatment outcomes [133,134]. Therefore, attention should be paid to local setting needs and cultural context when choosing to adopt any of the interventions with multistage effects to improve TB care cascade outcomes.…”