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Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda

Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting list...

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Autores principales: Kasozi, Samuel, Kirirabwa, Nicholas Sebuliba, Kimuli, Derrick, Luwaga, Henry, Kizito, Enock, Turyahabwe, Stavia, Lukoye, Deus, Byaruhanga, Raymond, Chen, Lisa, Suarez, Pedro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772013/
https://www.ncbi.nlm.nih.gov/pubmed/33373997
http://dx.doi.org/10.1371/journal.pone.0244451
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author Kasozi, Samuel
Kirirabwa, Nicholas Sebuliba
Kimuli, Derrick
Luwaga, Henry
Kizito, Enock
Turyahabwe, Stavia
Lukoye, Deus
Byaruhanga, Raymond
Chen, Lisa
Suarez, Pedro
author_facet Kasozi, Samuel
Kirirabwa, Nicholas Sebuliba
Kimuli, Derrick
Luwaga, Henry
Kizito, Enock
Turyahabwe, Stavia
Lukoye, Deus
Byaruhanga, Raymond
Chen, Lisa
Suarez, Pedro
author_sort Kasozi, Samuel
collection PubMed
description Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013–2015, the RR-TB/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.
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spelling pubmed-77720132021-01-08 Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda Kasozi, Samuel Kirirabwa, Nicholas Sebuliba Kimuli, Derrick Luwaga, Henry Kizito, Enock Turyahabwe, Stavia Lukoye, Deus Byaruhanga, Raymond Chen, Lisa Suarez, Pedro PLoS One Research Article Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013–2015, the RR-TB/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges. Public Library of Science 2020-12-29 /pmc/articles/PMC7772013/ /pubmed/33373997 http://dx.doi.org/10.1371/journal.pone.0244451 Text en © 2020 Kasozi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kasozi, Samuel
Kirirabwa, Nicholas Sebuliba
Kimuli, Derrick
Luwaga, Henry
Kizito, Enock
Turyahabwe, Stavia
Lukoye, Deus
Byaruhanga, Raymond
Chen, Lisa
Suarez, Pedro
Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda
title Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda
title_full Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda
title_fullStr Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda
title_full_unstemmed Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda
title_short Addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in Uganda
title_sort addressing the drug-resistant tuberculosis challenge through implementing a mixed model of care in uganda
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772013/
https://www.ncbi.nlm.nih.gov/pubmed/33373997
http://dx.doi.org/10.1371/journal.pone.0244451
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