Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

Oga‐Omenka, Charity; Tseja-Akinrin, Azhee; Sen, Paulami; Mac-Seing, Muriel; Agbaje, Aderonke; Menzies, Dick; Zarowsky, Christina

doi:10.1136/bmjgh-2019-002280

Cited by 38 publications

(53 citation statements)

References 56 publications

(71 reference statements)

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“…[31], [34]. [42] Transferred out 8 0,002 [31] Treatment outcome not evaluated in study 258295 62,42 [30], [32][33], [35][36][37][38] [41]…”

Section: Summary Of the Studies Reviewedmentioning

confidence: 99%

“…Socio-economic barriers affecting patient care included treatment distance, inaccessibility, transport costs and costs experienced during hospitalization [35]. Oga-Omenka et al (2020) identi ed the inability to pay care-related costs as a barrier for diagnosis and treatment of DR-TB [42] . There was also associated job losses and production time loss during the initial intensive phase of treatment [24,25].…”

Section: Economic Factors In Uencing Mdr-tbmentioning

confidence: 99%

“…The Mixed Method Quality Appraisal Tool (MMAT) Version 2018 [41] was utilized to assess the quality of all the included quantitative studies (17) while, The Critical Appraisal Skills Programme (CASP) [42] tool was used to assess the systematic reviews. .…”

Section: Quality Of Evidencementioning

confidence: 99%

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Socio-economic drivers of Drug-Resistant Tuberculosis in Africa: A Scoping Review

Cannon

Oladimeji

Goon

2020

Preprint

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Background: Drug-resistant TB (DR-TB) remains a public health concern due to the high morbidity and mortality rates from the disease. The DR-TB is a multifaceted illness with expensive treatment regimens, toxic medications and most often the long duration of treatment constitutes a substantial financial burden on both infected patients and the health system. Despite significant research advances in the diagnosis and treatment, there is a paucity of synthesized evidence on how socio-economic factors are associated with DR-TB. This review aims to address this gap by synthesizing available evidence and data on the common socio-economic drivers of DR-TB infection in Africa.Methods: A systematic search was conducted on PUBMED and Google Scholar databases from January 2011 to January 2020 using Joanna Briggs Institute’s scoping review approach. An updated search was conducted on 21 September 2020. The eligibility criteria only included systematic reviews and studies with quantitative research methods (cross-sectional, case-control, cohort, and randomized-control trials). Studies conducted in Africa and focusing on socio-economic factors influencing DR-TB burden in African countries were also considered. Data was extracted from all the studies that met the eligibility criteria based on the study’s objectives.Results: Out of the 154 articles that were retrieved for review, 20 abstracts of these articles met all the eligibility criteria. Of the 20 articles, 17 quantitative and 3 reviews. 2 additional articles were found eligible, following the updated search. The following themes were identified as major findings: Social and economic drivers associated with DR-TB. Substance abuse of which, stigma and discrimination were the prominent social drivers. Economic drivers included poverty, financial constraints because of job loss, loss of productive time during hospital admission and treatment costs.Conclusion: This review has highlighted which socio-economic factors contribute to DR- TB This is relevant to assist DR-TB management program and TB stakeholders in different settings to address identified socio-economic gaps and to reduce its negative impact on the programmatic management of DR TB. Therefore, redirecting strategies with more focus on socio-economic empowerment of DR-TB patients could be one of the innovative solutions to reduce the spread and eliminate DR-TB in Africa.

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“…[31], [34]. [42] Transferred out 8 0,002 [31] Treatment outcome not evaluated in study 258295 62,42 [30], [32][33], [35][36][37][38] [41]…”

Section: Summary Of the Studies Reviewedmentioning

confidence: 99%

Section: Economic Factors In Uencing Mdr-tbmentioning

confidence: 99%

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Socio-economic drivers of Drug-Resistant Tuberculosis in Africa: A Scoping Review

Cannon

Oladimeji

Goon

2020

Preprint

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“…The predominant theoretical framework guiding our transformative study is the Levesque patient-centred access to healthcare framework (12,14,19). We chose the Levesque framework as we identi ed from our initial literature review, published elsewhere (37), an interplay of factors, both between the health system (supply) and patient (demand) levels, and at different stages of care. The framework also allowed us to explore some dimensions of the quality of care (patient-centred, equity, accessibility) (38,39), which some authors have called the missing link in TB care (39,40), without losing focus on the supply and demand dynamics of access.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…In our literature review published earlier, we summarised recommendations made by the authors to improve the barriers to access by paired dimensions (37).…”

Section: Recommendationsmentioning

confidence: 99%

Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes

Oga‐Omenka

Bada

Agbaje

et al. 2020

Preprint

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Introduction: Persistent low rates of case notification and treatment coverage reflect that accessing free diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in Nigeria remains a challenge. Equity in health access requires availability of comparable, appropriate services to all, based on needs, and irrespective of socio-demographic characteristics. Our study analyzed elements that facilitate or hinder equitable access for different groups of patients within the current health system to support DR-TB management in Nigeria. Methods: We conducted documentary review of guidelines and workers manuals, as well as 29 qualitative interviews, including 5 focus group discussions, with a total of 62 participants, in Nigeria. Between August and November 2017, we conducted qualitative interviews of patients who were on treatment, their treatment supporter, and providers in Ogun and Plateau States, as well as program managers in Benue and Abuja. We adapted and used Levesque’s patient-centered access to care framework to analyze DR-TB policy documents and interview data. Results: Thematic analysis revealed inequitable access to DR-TB care for some patient socio-demographic groups. While patients were mostly treated equally at the facility level, some patients experienced more difficulty accessing care based on their gender, age, occupation, educational level and religion. Health system factors including positive provider attitudes and financial support provided to the patients facilitated equity and ease of access. However, limited coverage and the absence of patients’ access rights protection and considerations in the treatment guidelines and workers manuals likely hampered access. Conclusion: In the context of Nigeria’s low case-finding and treatment coverage, applying an equity of access framework was necessary to highlight gaps in care. Differing social contexts of patients adversely affected their access to DR-TB care. We identified several strengths in DR-TB care delivery, including the current financial support that should be sustained. Our findings highlight the need for government’s commitment and continued interventions.

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Nano-Medicine for Treatment of Tuberculosis, Promising Approaches Against Antimicrobial Resistance

Mobed,

Alivirdiloo,

Gholami

et al. 2024

Curr Microbiol

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Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

Cited by 38 publications

References 56 publications

Socio-economic drivers of Drug-Resistant Tuberculosis in Africa: A Scoping Review

Socio-economic drivers of Drug-Resistant Tuberculosis in Africa: A Scoping Review

Ease and equity of access to free DR-TB services in Nigeria- a qualitative analysis of policies, structures and processes

Nano-Medicine for Treatment of Tuberculosis, Promising Approaches Against Antimicrobial Resistance

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