Gaps related to screening and diagnosis of tuberculosis in care cascade in selected health facilities in East Africa countries: A retrospective study

Abstract

Introduction East Africa countries (Tanzania, Kenya, and Uganda) are among tuberculosis high burdened countries globally. As we race to accelerate progress towards a world free of tuberculosis by 2035, gaps related to screening and diagnosis in the cascade care need to be addressed. Methods We conducted a three-year (2015–2017) retrospective study using routine program data in 21 health facilities from East Africa. Data abstraction were done at tuberculosis clinics, outpatient departments (OPD), human immunodeficiency virus (HIV) and diabetic clinics, and then complemented with structured interviews with healthcare providers to identify possible gaps related to integration, screening, and diagnosis of tuberculosis. Data were analyzed using STATA™ Version 14.1. Results We extracted information from 49,454 presumptive TB patients who were registered in the 21 facilities between January 2015 and December 2017. A total of 9,565 tuberculosis cases were notified; 46.5% (4,450) were bacteriologically confirmed and 31.5% (3,013) were HIV-infected. Prevalence of tuberculosis among presumptive pulmonary tuberculosis cases was 17.4%. The outcomes observed were as follows: 79.8% (7,646) cured or completed treatment, 6.6% (634) died, 13.3% (1,270) lost to follow-up or undocumented and 0.4% (34) treatment failure. In all countries, tuberculosis screening was largely integrated at OPD and HIV clinics. High patient load, weak laboratory specimen referral system, shortage of trained personnel, and frequent interruption of laboratory supplies were the major cited challenges in screening and diagnosis of tuberculosis. Conclusion Screening and diagnostic activities were frequently affected by scarcity of human and financial resources. Tuberculosis screening was mainly integrated at OPD and HIV clinics, with less emphasis on the other health facility clinics. Closing gaps related to TB case finding and diagnosis in developing countries requires sustainable investment for both human and financial resources and strengthen the integration of TB activities within the health system.

Trends of notification rates and treatment outcomes of tuberculosis cases with and without HIV co-infection in eight rural districts of Uganda (2015 – 2019)

“…However, there are few reports from rural Uganda with which to compare the trend of the CNRs observed in our study. Similar to our finding, an increase in the number of notified cases was observed between 2015 – 2017 in a study that abstracted data from Kiboga, Mityana and Nakaseke district hospitals [ 16 ]. TB detection among HIV-infected and HIV-uninfected individuals could be increasing in this region.…”

“…Similar to our findings, a decline in the TSR was observed between 2015 – 2017 (from 73.4% to 64.4%) in a study that included data from Kiboga, Mityana and Nakaseke district hospitals, although data were not reported by HIV status [ 16 ]. Likewise, the majority with an unfavourable outcome in that study were mostly lost-to-follow up.…”

Implementation of Evidence-Based Multiple Focus Integrated Intensified TB Screening to End TB (EXIT-TB) package in East Africa: A Qualitative study

“…The parent study was a multi-country cluster randomized controlled trial where the unit of randomization was the facility [11]. The EXIT-TB package was implemented in a total of 4 urban and 3 rural facilities in each participating country.…”

Tuberculosis Prevalence and Predictors Among Health Care-Seeking People Screened for Cough of Any Duration in Ethiopia: A Multicenter Cross-Sectional Study

“…Under passive case finding an individual is required to report to a health facility for care. In Kenya, Tanzania, Sudan, Uganda, and Ethiopia, for an individual to be recognized as a presumptive TB patient, they need to report to a health facility with a cough of two or more weeks with or without accompanying symptoms (5,6), limiting the opportunity to capture those who report less duration of a cough, and women and children attending reproductive and child health (RCH) clinics. In these countries, screening for TB has largely been integrated to outpatients department (OPD) and HIV/AIDs clinics (5,6) but is challenged by high patient load, shortage of manpower and financing, and interruption of laboratory supplies (5,6).…”

“…In Kenya, Tanzania, Sudan, Uganda, and Ethiopia, for an individual to be recognized as a presumptive TB patient, they need to report to a health facility with a cough of two or more weeks with or without accompanying symptoms (5,6), limiting the opportunity to capture those who report less duration of a cough, and women and children attending reproductive and child health (RCH) clinics. In these countries, screening for TB has largely been integrated to outpatients department (OPD) and HIV/AIDs clinics (5,6) but is challenged by high patient load, shortage of manpower and financing, and interruption of laboratory supplies (5,6). To a large extent, passive case finding depends on individual self-initiative to visit a healthcare facility and report a cough with proper duration, and on a degree of alertness of health workers to identify a patient (7).…”