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. 2019 Jun;9(1):010423.
doi: 10.7189/jogh.09.010423.

Health systems performance in managing tuberculosis: analysis of tuberculosis care cascades among high-burden and non-high-burden countries

Jungyeon Kim  1 , Salmaan Keshavjee  2 , Rifat Atun  1   2
Affiliations

Health systems performance in managing tuberculosis: analysis of tuberculosis care cascades among high-burden and non-high-burden countries

Jungyeon Kim et al. J Glob Health. 2019 Jun.

Abstract

Background: Tuberculosis (TB) is a major global health burden, which has been inadequately addressed. This study aims to analyze different patterns and gaps of care along the care cascade across countries and to develop a model to examine the relationship between performance of tuberculosis programmes in high and low burden countries along the tuberculosis care cascade and tuberculosis disease burden.

Methods: We used the World Health Organization's Global TB Database for the year 2016 to construct tuberculosis care cascade consisting of four steps: incidence, diagnosed, treatment started and treatment completed. Based on the constructed care cascades, we analyzed the relationship between health system performance indicators and tuberculosis cascades performance: diagnosed rate, treatment started rate, and treatment completed rate.

Results: There are wide differences in access to diagnosis and treatment between high-burden countries and non-high-burden countries. The largest gap was found between incidence and diagnosed rate, with 65% of diagnosed rate for high burden countries and 80% of diagnosed rate for non-high burden countries. We found variations in care performance among high-burden countries. We found a negative relationship between the population health indicators related to the mortality rate and TB care cascade performance. There was a positive relationship between immunization coverage rate and antenatal care indicators and TB care cascade performance.

Conclusions: Well-functioning tuberculosis care cascades and effective health systems are important for the successful management of tuberculosis. While improving screening performance is essential for tuberculosis control especially for high-burden countries, resource should be allocated to improve health system performance, which is weak in high-burden countries. Performance of TB programmes across care cascade could be used as a useful tracer to measure performance of health systems.

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Conflict of interest statement

Competing interests: The authors completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request from the corresponding author), and declare no conflicts of interest.

Figures

Figure 1
Figure 1
TB care cascade for 30 high-burden countries, 2015. Diagnosed: 100 × [(sum of total of new and relapse cases and cases with unknown previous tuberculosis treatment, 2015)/(estimated number of incident cases (all forms), 2015)]. Treatment Started: 100 × [(sum of outcomes for all new and relapse cases: cohort size and outcomes for previously treated patients: cohort size, 2015)/(estimated number of incident cases (all forms), 2015)]. Treatment Completed: 100 × [(sum of outcomes for all new and relapse cases: treatment success (cured or treatment completed) and outcomes for previously treated patients: treatment success (cured or treatment completed)/ (estimated number of incident cases (all forms), 2015)].
Figure 2
Figure 2
TB care cascade for each of 30 high burden countries, 2015. Steps correspond to, in order, Incidence, Diagnosed, Treatment Started, and Treatment Completed.
Figure 3
Figure 3
TB care cascade for all the 30 high burden and 153 non-high burden countries, 2015.
Figure 4
Figure 4
TB care cascade for 153 non-high burden countries, 2015.
See this image and copyright information in PMC

References

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MeSH terms