Re-evaluating the merits of decentralization as a core strategy for effective delivery of drug-resistant tuberculosis care in Pakistan

被引：3

作者：

Khan, Uzma ^{[1
]}

Lotia-Farrukh, Ismat ^{[1
]}

Akhtar, Ahwaz ^{[2
]}

Khowaja, Saira N. ^{[1
]}

Khan, Salman ^{[3
]}

Madhani, Falak ^{[2
]}

Parekh, Asra ^{[1
]}

Adnan, Sana ^{[2
]}

Ahmed, Saman ^{[1
]}

Chaudhry, Mariam ^{[1
]}

Hussain, Hamidah ^{[1
]}

Habib, Ali ^{[4
]}

Butt, Shahid ^{[2
]}

Siddiqui, Muhammad R. ^{[3
,5
]}

Ijaz, Raafia ^{[2
]}

Jamal, Saba ^{[2
]}

Khan, Abdul B. ^{[2
]}

Keshavjee, Salmaan ^{[6
,7
]}

Khan, Aamir J. ^{[1
]}

Salahuddin, Naseem ^{[2
]}

Khan, Palwasha Y. ^{[1
,8
]}

机构：

[1] Interact Res & Dev, 4th Floor,Woodcraft Bldg,Plot 3 & 3-A,Sect 47, Karachi 75190, Pakistan

[2] Indus Hosp & Hlth Network, Plot C-76,Sect 31-5, Karachi 75190, Pakistan

[3] Prov TB Program, Sindh Secretariat 1,Kamal Atta Turk Rd, Karachi 75600, Sindh, Pakistan

[4] Interact Hlth Solut, Suite 503,Ibrahim Trade Tower, Karachi 75350, Sindh, Pakistan

[5] Inst Chest Dis, Kotri 76040, Sindh, Pakistan

[6] Harvard Univ, Cambridge, MA 02138 USA

[7] Brigham & Womens Hosp, Boston, MA 02115 USA

[8] London Sch Hyg & Trop Med, Keppel St, London WC1E 7HT, England

来源：

HEALTH POLICY AND PLANNING | 2022年 / 37卷 / 08期

关键词：

Tuberculosis; decentralization; community; health outcomes; lung disease; developing countries; geographical information systems; infectious diseases; SERVICES; HEALTH; TB;

D O I：

10.1093/heapol/czac038

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

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.

引用

页码：979 / 989

页数：11

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