Do private health providers adhere to National Tuberculosis Guideline while assigning treatment outcome? Findings from a lower middle-income country

Abstract

BackgroundTreatment success rate is an important indicator to measure the performance of the National Tuberculosis Program (NTP). There are concerns about the quality of outcome data from private facilities engaged by NTP. Adherence of private providers of tuberculosis care to NTP guideline while assigning treatment outcomes to patients is rarely investigated. We aimed to determine whether Lagos private for-profit (PFP) and private not-for-profit (PNFP) facilities adhere to domestic TB guideline while assigning treatment outcome and the availability of periodic sputum acid-fast bacilli (AFB) results.MethodA retrospective review of facility treatment register and treatment cards of TB patients managed between January and December 2016 across 10 private directly observed treatment short-course (DOTS) facilities involved in the public–private mix (PPM) in Lagos, Nigeria. The study took place between January and June 2019.ResultsOf the 1,566 patients, majority (60.7%) were male, >30 years (50.2%), HIV-negative (88.4%), and attended PNFP (78.5%). The reported treatment success rate (TSR) was 84.2% while the actual TSR was 53.8%. In total, 91.1, 77.6, and 70.3% of patients had sputum acid-fast bacilli (AFB) at 2/3, month 5, and month 6, respectively, while 68.6% had all the three sputum AFB in the register. Healthcare workers (HCWs) were adherent in assigning treatment outcome for 65.6% of TB patients while 34.4% of patients were assigned incorrect treatment outcomes. Most variations between reported and actual treatment outcomes were found with cured (17%) and completed (13.4%). Successful and unsuccessful outcomes were overreported by 30.4% and 4.1%, respectively. DOTS providers in private facilities with available TB guideline (OR 8.33, CI 3.56–19.49, p < 0.0001) and PNFP facility (OR 4.42, CI 1.91–10.3, p = 0.001) were more likely to adhere to National TB Guideline while assigning TB treatment outcome.ConclusionFrontline TB providers in Lagos private hospitals struggled with assigning correct treatment outcome for TB patients based on NTBLCP guideline. Increased access to all the periodic follow-up AFB tests for TB patients on treatment and availability of National TB Guideline for referencing could potentially improve the adherence of private TB service providers while assigning TB treatment outcomes.

Public–Private Mix (PPM) for Tuberculosis (TB) in Urban Health Systems in Least Developed, Low Income and Lower-Middle-Income Countries and Territories – A Systematic Review

“…Some recent studies have explored solutions to the system challenges identified such as inconsistent implementation of NTP guidelines, uncoordinated referrals, and lack of trust among partners. A study from Nigeria has recommended making less bulky and more precise NTP guidelines available at all levels of care, as well as training intensification for PPs to improve adherence (96). In another study, a Hub and Spoke model improved the referral system and uptake of GeneXpert testing after a coordinated engagement of private laboratories (97).…”

Systematic review and meta-analysis of Tuberculosis and COVID-19 Co-infection: Prevalence, fatality, and treatment considerations

“…Secondly, the disruption in TB care services might result in insufficient treatment for numerous co-infected individuals, potentially contributing to preventable deaths. This concern is particularly pronounced in LMICs, where healthcare services are often limited and of lower quality [ 40 , 41 ]. Additionally, the decrease in discovered cases of TB could contribute to a lower total number of identified co-infected patients.…”