Evaluating TB diagnosis and care in the Union of the Comoros

SETTING: The Union of the Comoros has experienced a persistent notification gap in TB cases despite several strategic changes, including molecular diagnosis and contact investigation. We therefore performed a TB patient pathway analysis (PPA) under the National Tuberculosis Programme (NTP). OBJECTIV...

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Bibliographic Details
Published in:	Public health action Vol. 13; no. 1; pp. 23 - 27
Main Authors:	Noeske, J., Mzembaba, A., Assoumani, Y., Maoulida, S., Makpenon, A.
Format:	Journal Article
Language:	English
Published:	France International Union Against Tuberculosis and Lung Disease 21-03-2023
Subjects:	Care-Seeking Comoros Missing Cases Original Patient Pathway Analysis Ppa Tuberculosis PPA missing cases care-seeking patient pathway analysis Comoros tuberculosis
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Summary:	SETTING: The Union of the Comoros has experienced a persistent notification gap in TB cases despite several strategic changes, including molecular diagnosis and contact investigation. We therefore performed a TB patient pathway analysis (PPA) under the National Tuberculosis Programme (NTP). OBJECTIVE: To assess the alignment of healthcare-seeking behaviour and TB service availability to clarify the reasons for these missing cases. DESIGN: Three primary data sources, including a national list of health facilities, TB surveillance data and care-seeking behaviour data, were analysed at the national and regional levels to determine access to TB diagnosis and the initial point of care-seeking. Summary data were visualised using the standardised PPA Wizard programme, and the analysis was completed using demographic and socio-economic data. RESULTS: At the initial point of care-seeking, 18% of patients had access to TB services, available only in nine centralised public health facilities. Furthermore, 30% of patients initially consulted in the informal sector and 45% in the formal public or private sector in health facilities, both of which lacked the capacity for TB diagnosis or first-line treatment. CONCLUSION: The concentration of and limited access to TB services at the intermediate and central levels of care indicate a need for decentralisation efforts.
Bibliography:	2220-8372(20230321)13:1L.23;1- ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2220-8372 2220-8372
DOI:	10.5588/pha.22.0057