Re-evaluating the merits of decentralization as a core strategy for effective delivery of drug-resistant tuberculosis care in Pakistan.
Uzma KhanIsmat Lotia-FarrukhAhwaz AkhtarSaira N KhowajaSalman KhanFalak MadhaniAsra ParekhSana AdnanSaman AhmedMariam ChaudhryHamidah HussainAli HabibShahid ButtMuhammad R SiddiquiRaafia IjazSaba JamalAbdul B KhanSalmaan KeshavjeeAamir J KhanNaseem SalahuddinPalwasha Y KhanPublished in: Health policy and planning (2022)
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models-made increasingly urgent by the COVID-19 pandemic-are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005-1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential.
Keyphrases
- mycobacterium tuberculosis
- drug resistant
- multidrug resistant
- healthcare
- acinetobacter baumannii
- quality improvement
- palliative care
- end stage renal disease
- gram negative
- pulmonary tuberculosis
- ejection fraction
- newly diagnosed
- affordable care act
- chronic kidney disease
- klebsiella pneumoniae
- editorial comment
- pain management
- peritoneal dialysis
- clinical trial
- prognostic factors
- escherichia coli
- patient reported outcomes
- type diabetes
- risk factors
- pseudomonas aeruginosa
- south africa
- metabolic syndrome
- case report
- skeletal muscle
- study protocol
- health insurance
- tertiary care
- deep learning
- adverse drug
- human immunodeficiency virus