Where are the missing people affected by tuberculosis? A programme review of patient-pathway and cascade of care to optimise tuberculosis case-finding, treatment and prevention in Cambodia

Abstract

BackgroundCambodia has achieved great success in tuberculosis (TB) control in the past decade. Nevertheless, people with TB are missed by the health systems at different stages of the care pathway. This programme review corroborated the care-seeking behaviours of people with TB and TB services availability and estimated the number of people completing each step of the TB disease and TB preventive treatment (TPT) care cascade.MethodsPatient pathways and the care cascades for TB disease and TPT were constructed using data from the latest national TB prevalence survey, routine surveillance and programme, the global TB database and published studies. We also randomly selected TB survivors in the 2019 cohort to assess recurrence-free survival 1-year post-treatment. TPT care cascade was constructed for people living with HIV (PLHIV) and household contacts (children <5 years and all ages) of persons with bacteriologically-confirmed TB in 2019 and 2020.ResultsNationally, 54% of those who exhibited TB symptoms sought initial care in the private sector. Overall, 93% and 58% of people with presumptive TB did not access a facility with TB diagnostic and treatment services, respectively, at the first point of care-seeking. Approximately 56% (95% CI 52% to 57%) of the 47 000 (95% CI 31 000 to 68 000) estimated TB cases in 2019 achieved recurrence-free survival. Among the estimated PLHIV in Cambodia, <30% completed TPT. Among children <5 years, 53% (95% CI 29% to 65%) (2019) and 67% (95% CI 36% to 80%) (2020) of those eligible for TPT completed the regimen successfully. In 2019 and 2020, 23% (95% CI 22% to 25%) and 54% (95% CI 50% to 58%) of the estimated household contacts (all ages) eligible for TPT completed the regimen successfully.ConclusionThere are significant gaps in care-seeking, coverage and access to TB services and TPT in Cambodia. Action plans to improve TB response have been co-developed with local stakeholders to address the gaps throughout the care cascades.

Exploring the Role of the Private Sector in Tuberculosis Detection and Management in Lima, Peru: A Mixed-Methods Patient Pathway Analysis

“…Some PPA studies have revealed a lack of basic information on TB diagnostic service availability in the private sector, as government regulatory agencies do not cover private facilities comprehensively. 3 , 7 , 12 Yet in Asia and Africa, engaging the private sector has been shown consistently to increase TB case detection and improve treatment outcomes, and various models for partnership exist. 13 …”

“…Some PPA studies have revealed a lack of basic information on TB diagnostic service availability in the private sector, as government regulatory agencies do not cover private facilities comprehensively. 3,7,12 Yet in Asia and Africa, engaging the private sector has been shown consistently to increase TB case detection and improve treatment outcomes, and various models for partnership exist. 13 Despite private health-care providers playing an increasingly significant role in health-care delivery in Latin American nations, the literature on the involvement of private healthcare providers in TB detection and management for this region is limited.…”

Exploring the role of the private sector in tuberculosis detection and management in Lima, Peru: a mixed-methods patient pathway analysis

“…Some PPA studies have revealed a lack of basic information on TB diagnostic service availability in the private sector, as government regulatory agencies do not comprehensively cover private facilities. 3,7,11 Yet in Asia and Africa, engaging the private sector has consistently been shown to increase TB case detection and improve treatment outcomes, and various models for partnership exist. 12 Despite private healthcare providers playing an increasingly significant role in healthcare delivery in Latin American nations, the literature on the involvement of private healthcare providers in TB detection and management for this region is limited.…”