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Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers

Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through th...

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Autores principales: Rosapep, Lauren A., Faye, Sophie, Johns, Benjamin, Olusola-Faleye, Bolanle, Baruwa, Elaine M., Sorum, Micah K., Nwagagbo, Flora, Adamu, Abdu A., Kwan, Ada, Obanubi, Christopher, Atobatele, Akinyemi Olumuyiwa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021846/
https://www.ncbi.nlm.nih.gov/pubmed/36962145
http://dx.doi.org/10.1371/journal.pgph.0000150
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author Rosapep, Lauren A.
Faye, Sophie
Johns, Benjamin
Olusola-Faleye, Bolanle
Baruwa, Elaine M.
Sorum, Micah K.
Nwagagbo, Flora
Adamu, Abdu A.
Kwan, Ada
Obanubi, Christopher
Atobatele, Akinyemi Olumuyiwa
author_facet Rosapep, Lauren A.
Faye, Sophie
Johns, Benjamin
Olusola-Faleye, Bolanle
Baruwa, Elaine M.
Sorum, Micah K.
Nwagagbo, Flora
Adamu, Abdu A.
Kwan, Ada
Obanubi, Christopher
Atobatele, Akinyemi Olumuyiwa
author_sort Rosapep, Lauren A.
collection PubMed
description Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a “textbook” case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers’ adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers’ TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria’s national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions.
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spelling pubmed-100218462023-03-17 Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers Rosapep, Lauren A. Faye, Sophie Johns, Benjamin Olusola-Faleye, Bolanle Baruwa, Elaine M. Sorum, Micah K. Nwagagbo, Flora Adamu, Abdu A. Kwan, Ada Obanubi, Christopher Atobatele, Akinyemi Olumuyiwa PLOS Glob Public Health Research Article Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a “textbook” case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers’ adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers’ TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria’s national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions. Public Library of Science 2022-01-06 /pmc/articles/PMC10021846/ /pubmed/36962145 http://dx.doi.org/10.1371/journal.pgph.0000150 Text en https://creativecommons.org/publicdomain/zero/1.0/This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 (https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication.
spellingShingle Research Article
Rosapep, Lauren A.
Faye, Sophie
Johns, Benjamin
Olusola-Faleye, Bolanle
Baruwa, Elaine M.
Sorum, Micah K.
Nwagagbo, Flora
Adamu, Abdu A.
Kwan, Ada
Obanubi, Christopher
Atobatele, Akinyemi Olumuyiwa
Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers
title Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers
title_full Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers
title_fullStr Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers
title_full_unstemmed Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers
title_short Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers
title_sort tuberculosis care quality in urban nigeria: a cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10021846/
https://www.ncbi.nlm.nih.gov/pubmed/36962145
http://dx.doi.org/10.1371/journal.pgph.0000150
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