Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care

Abstract

The cascade of care is a model for evaluating patient retention across sequential stages of care required to achieve a successful treatment outcome. This approach was first used to evaluate HIV care and has since been applied to other diseases. The tuberculosis (TB) community has only recently started using care cascade analyses to quantify gaps in quality of care. In this article, we describe methods for estimating gaps (patient losses) and steps (patients retained) in the care cascade for active TB disease. We highlight approaches for overcoming challenges in constructing the TB care cascade, which include difficulties in estimating the population-level burden of disease and the diagnostic gap due to the limited sensitivity of TB diagnostic tests. We also describe potential uses of this model for evaluating the impact of interventions to improve case finding, diagnosis, linkage to care, retention in care, and post-treatment monitoring of TB patients.

Using community health workers for facility and community based TB case finding: An evaluation in central Mozambique

“…There have been various community TB CHW activities, but these have been fragmented, involved different strategies, and did not utilize a standardized monitoring and evaluation (M&E) framework. As recommended by the WHO and others [34][35][36], this has started to change with specific projects supported by USAID such as the recent Challenge TB (CTB) Project in Sofala, Nampula, Tete and Zambezia provinces. TB notifications increased substantially during the recent CTB project which has a strong CHW community TB-case finding element, but most of the additional individuals were not B+, which is surprising given the recent scale-up of LED microscopy and Xpert MTB/RIF testing in Mozambique.…”

Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India

“…Tuberculosis (TB) care may be undermined by patient loss to follow-up across sequential steps from care seeking to successful treatment, comprising the care cascade 1. Pretreatment loss to follow-up (PTLFU), which refers to patient losses after diagnosis but before treatment registration, is a key gap in the care cascade in several high TB burden countries 2 3.…”

Role of community health workers in improving cost efficiency in an active case finding tuberculosis programme: an operational research study from rural Bihar, India

“…Consequently, they can leverage their unique position by acting as patient navigators and ensuring that they complete their pathways to treatment completion. [33][34][35] Involving CHWs can also aid in engaging other actors like informal health providers and community in the way they referred people to be screened in our intervention. Their role, although, was ancillary while the FCs screened and diagnosis and treatment activities for such cases were undertaken by the CHWs.…”