Mobilising community networks for early identification of tuberculosis and treatment initiation in Cambodia: an evaluation of a seed-and-recruit model

Teo, Alvin Kuo Jing; Prem, Kiesha; Tuot, Sovannary; Ork, Chetra; Eng, Sothearith; Pande, Tripti; Chry, Monyrath; Hsu, Li Yang; Yi, Siyan

doi:10.1183/23120541.00368-2019

Cited by 10 publications

(10 citation statements)

References 35 publications

(6 reference statements)

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“…Our analyses revealed a substantial delay between the onset of TB symptoms and TB care-seeking among high burden countries, highlighting the need to continue to shape knowledge, change attitude, and raise awareness of the community, people at risk of TB, and the health providers. Specific vulnerabilities such as sex disparities in care-seeking, being older, and geographic isolation should be recognized and addressed through tailored approaches to improve access to TB services and early diagnosis [ 184 ]. It is also crucial to improve the consciousness of the society regarding TB to battle stigma, and networks [ 185 ] of support from within the families, the grassroots, and institutions could create an enabling environment for early care-seeking and treatment adherence and success.…”

Section: Discussionmentioning

confidence: 99%

Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

et al. 2021

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Background Thirty countries with the highest tuberculosis (TB) burden bear 87% of the world’s TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the duration and determinants of delayed diagnosis and treatment of pulmonary TB in high TB-burden countries. Methods We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. We performed a narrative synthesis of the covariates significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. Results This review included 124 articles from 14 low- and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC). The pooled median duration of delays (in days) were—patient delay (LIC/LMIC: 28 (95% CI 20–30); UMIC: 10 (95% CI 10–20), health system delay (LIC/LMIC: 14 (95% CI 2–28); UMIC: 4 (95% CI 2–4), and treatment delay (LIC/LMIC: 14 (95% CI 3–84); UMIC: 0 (95% CI 0–1). There was consistent evidence that being female and rural residence was associated with longer patient delay. Patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Organizational and policy factors mediated health system and treatment delays. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high-burden countries. Conclusions This review presented the duration of delays and detailed the determinants of delayed TB diagnosis and treatment in high-burden countries. The gaps identified could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care. PROSPERO registration: CRD42018107237.

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Section: Discussionmentioning

confidence: 99%

Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

et al. 2021

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“…Although our study did not evaluate the effect of C-DOTS on TB stigma, it reinforced the notion of community mobilization and support in TB care. A separate study on the same population has empirically shown that a TB case-finding strategy that mobilizes the community to find and refer people presumptive of TB living in the same community has led to early identification of TB and treatment initiation [ 14 ]. Therefore, it is vital to continue recognizing the roles of the people affected by TB and rally community-driven approaches in monitoring and combatting stigma and ending TB.…”

Section: Discussionmentioning

confidence: 99%

“…For the IDIs, we purposively selected participants from the same cohort based upon maximum variation on these criteria—care-seeking behavior (short delay/long delay to TB diagnosis), sex (men/women), and residence (urban/rural). The details of the study population and TB diagnostic criteria have been described elsewhere [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia

Teo

Tan

Smyth³

et al. 2020

Open Forum Infectious Diseases

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Background Stigma is a significant barrier to healthcare and a factor that drives the global burden of tuberculosis (TB). However, there is a scarcity of information on TB stigma in developing countries. We aimed to characterize, measure, and explore the determinants of TB stigma among people with TB in Cambodia. Methods We conducted a mixed-methods study between February and August 2019 using a triangulation convergent design—a cross-sectional survey (n = 730) and nested in-depth interviews (n = 31) among people with TB. Quantitative data were analyzed using descriptive statistics and generalized linear regression models. Qualitative transcripts were thematically analyzed. Results A total of 56% and 51% of participants experienced self-stigma and perceived stigma by the community, respectively. We found rural dwellers, knowledge of how TB is transmitted, and knowledge that anybody can get TB were associated with higher levels of self-stigma and perceived stigma by the community. Higher scores on knowledge of TB symptoms were inversely associated with both self-stigma and community stigma. Thematic analyses revealed accounts of experienced stigma, acts of intentional distancing and hiding TB diagnosis from others, and feelings of embarrassment and shame. Conclusions Tuberculosis stigma was prevalent, suggesting a need for the incorporation of stigma-reduction strategies in the national TB responses. These strategies should be contextualized and developed through community engagement. Future research should continue to measure the levels and dimensions of TB stigma among people with TB through behavioral surveillance using standardized tools.

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“…Our analyses revealed a substantial delay between the onset of TB symptoms and TB care-seeking among high burden countries, highlighting the need to continue to shape knowledge, change attitude, and raise awareness of the community, people at risk of TB, and the health providers. To improve access to TB services and early diagnosis, specific vulnerabilities such as sex disparities in careseeking, being older, and geographic isolation should be recognized and addressed through tailored approaches [180] It is also crucial to improve consciousness of the society regarding TB to battle stigma, and networks [181] of support from within the families, the grassroots, and institutions could create an enabling environment for early care-seeking, treatment adherence and success. In contrast to patient delay, the shorter health system and treatment delay were encouraging.…”

Section: Discussionmentioning

confidence: 99%

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Teo¹,

Singh

Prem

et al. 2020

Preprint

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Background: Globally, 30 countries with the highest tuberculosis (TB) burden bears 87% of the world’s TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the determinants and duration of delayed diagnosis and treatment of pulmonary TB in high TB burden countries. Methods: We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. For quantitative studies, we performed narrative synthesis of the covariates that were significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. Results: We included 124 articles from 14 low-and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC) in this review. The pooled median duration of patient, health system, and treatment delay were 28 days (95%CI 20–30), 11.5 days (95%CI 3.9–24.7), and six days (95%CI 1–28.4), respectively. We found that the duration of delays was consistently shorter among UMIC compared to LIC and LMIC. There was consistent evidence that being female and rural residence was associated with longer patient delay. Furthermore, patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Health system and treatment delay were mediated by organizational and policy factors. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high burden countries. Conclusions: This review detailed the determinants of delayed TB diagnosis and treatment in high burden countries. The gaps identified at different socio-ecological levels could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care.

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Mobilising community networks for early identification of tuberculosis and treatment initiation in Cambodia: an evaluation of a seed-and-recruit model

Cited by 10 publications

References 35 publications

Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis

Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

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