Contributing Factors in the Tuberculosis Care Cascade in India: A Systematic Literature Review

Abstract

Tuberculosis (TB) care cascade is a recently evolved care model for patient retention across the sequential stages of care for a successful treatment outcome. The care cascade is multi-folded and complex in setting where the health system is reforming for its resilience. India, one of the countries with the highest burden of tuberculosis mortality and morbidity, is not an exception to this complexity. With the diverse challenges in the Indian health system and societal diversity, it is essential to understand the factors contributing to this TB care cascade. Thus, this study aims to map all the contributing factors to the TB care cascade in India. Further, it also captures the different patterns of factors explored so far in different countries’ regions. This systematic literature review was conducted between October 2020 and February 2021 in India using PubMed databases, Web of Science, and Google Scholar. Two reviewers extracted the data from eligible studies to summarize and tabulate important findings. Data were extracted and tabulated for study design, location of the study, type of TB patients, methodological approach, system side challenges, and demand-side challenges in the study’s findings. Out of 692 initial hits from the literature search, 28 studies were finally included to synthesize evidence in this review as per the inclusion and exclusion criteria. This review provides an insight into different factors such as the system-side (health workforce, institutional) and the demand-side (individual, societal) contributing towards the care cascade. The prime factors reflected in most of the studies were socio-economic condition, disease awareness, myths/beliefs, addictions among the demand-side factors and accessibility, the attitude of the healthcare staff, delay in referral for diagnosis among the system-side factors. The accountability for addressing these diverse factors is recommended to close the gaps in the TB care cascade.

Awareness about tuberculosis in a rural area of Mandya district: A cross-sectional study in southern Karnataka

“…Our study finding of higher level of education, having better odds (odds ratio ranging from 4.867 to 19.366) of TB knowledge, was also shown by study done by other studies . [ 6 11 19 20 21 22 23 24 25 26 27 28 29 ]…”

Assessing the quality of tuberculosis care using routine surveillance data: a process evaluation employing the Zero TB Indicator Framework in Mongolia

“…This approach may be generalisable to other high-burden settings that employ WHO’s standardised approach to TB monitoring and reporting 56 57. To complement such analyses, there is a need to incorporate qualitative and mixed-methods studies31 58 59 to contextualise the barriers and facilitators of care processes, as well as structural assessments of quality such as service availability and readiness surveys,60 to help enhance the outcomes of TB care 61. Above all, it is time for researchers and practitioners to strengthen routine TB surveillance data systems to collect rigorous, accessible, and reliable data on the quality of TB services worldwide.…”

“…[9][10][11] If improving quality is to be 'hard-wired' into NTPs, as a recent Lancet Commission on Tuberculosis recommended, 12 there is an urgent need for research on expanding measures of quality for use as benchmarks, as called for by the WHO TB Programme 13 and others, 14 starting with measures that make better use of routine TB surveillance data. 15 Structured evaluations of care processes through cascade analyses have increasingly been proposed 14 16-21 and implemented to describe gaps in quality of TB care in low-income and middle-income countries, including for clinic-based TB diagnosis and treatment in adults [22][23][24][25][26][27][28][29][30][31] and children, 32 33 active case-finding 28 34 35 and prevention 28 36 37 (online supplemental appendix S1). The Zero TB Initiative 38 has introduced an expansive quality indicator framework that integrates all three of these cascade types 18 ; similar approaches have been proposed for persons living with HIV.…”

“…Structured evaluations of care processes through cascade analyses have increasingly been proposed14 16–21 and implemented to describe gaps in quality of TB care in low-income and middle-income countries, including for clinic-based TB diagnosis and treatment in adults22–31 and children,32 33 active case-finding28 34 35 and prevention28 36 37 (online supplemental appendix S1). The Zero TB Initiative38 has introduced an expansive quality indicator framework that integrates all three of these cascade types18; similar approaches have been proposed for persons living with HIV 17.…”

National Tuberculosis Elimination Program Guidelines and its Relevance to the Indian Population in the Post-COVID-19 Pandemic Era

“…More than one-fourth of all tuberculosis cases are seen in India. Also, India witnessed more than 44 million Covid-19 cases and recorded more than 500,000 deaths related to the viral illness 7 . This unexpected pandemic further adversely affected those with pre-existing comorbid illnesses 8,9 .…”