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Review
. 2017 Mar:56:111-116.
doi: 10.1016/j.ijid.2016.10.016. Epub 2016 Oct 26.

Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade

Danielle Cazabon  1 , Hannah Alsdurf  1 , Srinath Satyanarayana  1 , Ruvandhi Nathavitharana  2 , Ramnath Subbaraman  3 , Amrita Daftary  4 , Madhukar Pai  5
Affiliations
Review

Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade

Danielle Cazabon et al. Int J Infect Dis. 2017 Mar.

Abstract

Despite the high coverage of directly observed treatment short-course (DOTS), tuberculosis (TB) continues to affect 10.4 million people each year, and kills 1.8 million. High TB mortality, the large number of missing TB cases, the emergence of severe forms of drug resistance, and the slow decline in TB incidence indicate that merely expanding the coverage of TB services is insufficient to end the epidemic. In the era of the End TB Strategy, we need to think beyond coverage and start focusing on the quality of TB care that is routinely offered to patients in high burden countries, in both public and private sectors. In this review, current evidence on the quality of TB care in high burden countries, major gaps in the quality of care, and some novel efforts to measure and improve the quality of care are described. Based on systematic reviews on the quality of TB care or surrogates of quality (e.g., TB diagnostic delays), analyses of TB care cascades, and newer studies that directly measure quality of care, it is shown that the quality of care in both the public and private sector falls short of international standards and urgently needs improvement. National TB programs will therefore need to systematically measure and improve quality of TB care and invest in quality improvement programs.

Keywords: Cascade of care; Quality improvement; Quality of care; Standards for TB care; Tuberculosis.

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Conflict of interest statement

Conflicts of interest:

None of the authors have financial or industry conflicts to disclose. MP serves as a consultant to the Bill & Melinda Gates Foundation, and on advisory committees of FIND, Geneva, and TB Alliance, New York. These agencies had no involvement in this manuscript.

Figures

Figure 1
Figure 1
Losses and drop-outs at each stage of the cascade of care in latent tuberculosis infection (LTBI). Numbers in parentheses are 95% CIs. The value for each level is calculated as the product of the value from the preceding step, multiplied by the pooled estimate for that step (from fixed-effects analysis).
Figure 2
Figure 2
Analysis of the HIV cascade of care, comparing the UNAIDS targets for 2020 with global estimates for 2014/15.
Figure 3
Figure 3
The cascade of care for all forms of tuberculosis in India’s Revised National Tuberculosis Control Programme (RNTCP) in India, 2013. Error bars depict 95% confidence 739 intervals.
Figure 4
Figure 4
The tuberculosis cascade of care for multidrug-resistant tuberculosis (MDR-TB) patients detected and treated by the Revised National Tuberculosis Control Programme (RNTCP) in India, 2013. Error bars depict 95%confidence intervals for each estimate.
See this image and copyright information in PMC

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