Table 1.
Key messages from the articles in the series on quality of care.
| Focus (reference) | Authors | Abstract |
|---|---|---|
| Lessons on quality of TB diagnosis from standardized patients [2] | Benjamin Daniels, Ada Kwan, Madhukar Pai, Jishnu Das | Standardized patient (SP) studies in India, China, South Africa and Kenya show that in general quality of TB care is low: relatively few SPs were offered appropriate diagnostic tests but 83% of interactions resulted in prescription of medication, frequently inappropriate broad-spectrum antibiotics, fluoroquinolones and steroids |
| Quality of drug-resistant tuberculosis care: Gaps and solutions [3] | Zarir Udwadia, Jennifer Furin | There is a quality crisis in the field of drug-resistant tuberculosis (DR-TB) care. DR-TB care is unsafe, inequitable, not patient-centred, and ineffective. The paper posits strategies to improve quality of care and advocates for a human-rights based approach to DR-TB care |
| In the eye of the multiple beholders: Qualitative research perspectives on studying and encouraging quality of TB care in India [4] | Andrew McDowell, Nora Engel, Amrita Daftary | Three qualitative case studies on TB diagnosis in India. (1) “Know-do” gap: GPs know best practices but don’t implement them. (2) Quality of care is limited by health system issues, even with easy-to-use diagnostics. (3) Patients in private pharmacies expect to receive tangible products. Pharmacists can “dispense” free vouchers for TB screening tests |
| Measuring and improving the quality of tuberculosis care: A framework and implications from the Lancet Global Health Commission [5] | Catherine Arsenault, Sanam Roder-DeWan, Margaret E. Kruk | Expanding diagnosis and treatment coverage alone will not create a TB-free world; high-quality health systems are essential. Efforts should focus on governing for quality, redesigning service delivery, transforming the health workforce and igniting demand for quality TB services |
| Implementing quality improvement in tuberculosis programming: Lessons learned from the global HIV response [6] | Daniel J. Ikeda, Apollo Basenero, Joseph Murungu, Margareth Jasmin, … Bruce D. Agins | Lessons learned from successful QI programs for HIV can guide improvements in TB care quality. QI programs should be NTP-coordinated. NTPs should develop comprehensive frameworks for QI capacity building, specifying curricula and standards for training at all health system levels in both public and private sectors, with scalability planned from the outset |
| Quality of TB services assessment: The unique contribution of patient and provider perspectives in identifying and addressing gaps in the quality of TB services [7] | Charlotte Colvin, Gretchen De Silva, Celine Garfin, Soumya Alva, … Jeanne Chauffour | The quality of TB services assessment (QTSA) aims to identify gaps in TB services and prioritize ways to improve care. A recent QTSA in the Philippines showed that providers report having counselled patients on TB more than patients report having received the information |
| The high-quality health system ‘revolution’: Re-imagining tuberculosis infection prevention and control [8] | Helene-Mari van der Westhuizen, Ruvandhi R. Nathavitharana, Clio Pillay, Ingrid Schoeman, Rodney Ehrlich | TB infection prevention and control (IPC) implementation should be linked with health system strengthening, moving it from the silo of NTPs, with IPC viewed as a system-wide goal rather than the responsibility of individual healthcare workers. Patient experience should be added to the definition of high-quality care |
| Quality of life with tuberculosis [9] | Ashutosh N. Aggarwal | Diminished capacity to work, social stigmatization, and psychological issues worsen quality of life (QOL) in TB patients. Governments and program managers need to step up socio-cultural reforms, health education, and additional support to patients to counter impairment in QOL |
| Quality of TB care among people living with HIV: Gaps and solutions [10] | Kogieleum Naidoo, Santhanalakshmi Gengiah, Satvinder Singh, Jonathan Stillo, Nesri Padayatchi | Gaps within HIV-TB care cascades must be systematically analysed. HIV-infected patients often present asymptomatically with TB and are under-evaluated with routinely available diagnostics. HIV-TB patients can have poor treatment outcomes due to unmanageable side effects of concomitant TB therapy and ART and the financial expense of multiple health visits |
| Closing gaps in the tuberculosis care cascade: an action-oriented research agenda [11] | Ramnath Subbaraman, Tulip Jhaveri, Ruvandhi R. Nathavitharana | Many people with active TB suffer poor outcomes at critical points in the health system, highlighting poor quality of TB care. The proposed research agenda asks: 1) Who is falling out of the TB care cascade?, 2) Why are patients falling out of the cascade?, and 3) What interventions are needed to reduce gaps in the care cascade? |
| Quality matters: Redefining child TB care with an emphasis on quality [12] | Farhana Amanullah, Jason Michael Bacha, Lucia Gonzalez Fernandez, Anna Maria Mandalakas | Child TB often presents like non-TB pneumonia or with difficult-to-diagnose extrapulmonary TB. Bacteriological confirmation is challenging. Children are rarely included in Phase 3 trials so have delayed access to new medications. Child TB cascade data is rarely available. The authors present a framework to improve the quality of child TB care |
| Quality of tuberculosis care by pharmacies in low- and middle-income countries: Gaps and opportunities [13] | Rosalind Miller, Catherine Goodman | The quality of pharmaceutical TB care has historically been poor. Interventions should expand beyond case detection to improve counselling of patients and appropriate medicine sales. Key areas for attention include pharmacy-specific global guidelines and the regulatory environment |
| Implementation science to improve the quality of tuberculosis diagnostic services in Uganda [14] | Adithya Cattamanchi, Christopher A. Berger, Priya B. Shete, Stavia Turyahabwe, … Achilles Katamba | System-level barriers lower the quality of care in Uganda, despite Xpert availability. Only 20% of patients with presumed TB received Xpert testing and nearly half with positive Xpert results were not rapidly linked to treatment. The authors conclude that Xpert scale-up should be accompanied by health system cointerventions to facilitate effective implementation |
| Identifying gaps in the quality of latent tuberculosis infection care [15] | Hannah Alsdurf, Dick Menzies | Quality care for LTBI must address key challenges including low prioritization of LTBI, provider knowledge gaps about testing and treatment, and patient concerns about side effects of preventive treatment. TB programmes need to ensure that these issues are addressed in a patient-centred manner |
| User experience and patient satisfaction with tuberculosis care in low- and middle-income countries: A systematic review [16] | Danielle Cazabon, Tripti Pande, Paulami Sen, Amrita Daftary, … Madhukar Pai | Most patients reported high satisfaction, despite widespread evidence of low-quality TB care. This could be due to acquiescence response bias, low expectations or because patients fear loss of services if they express dissatisfaction. The authors note the lack of standardized tools for measuring patient satisfaction and recommend their development. |
| Tuberculosis deaths are predictable and preventable: Comprehensive assessment and clinical care is the key [17] | Anurag Bhargava, Madhavi Bhargava | Comprehensive assessment and clinical care are required to reduce TB morbidity and mortality. TB programs need to define criteria for inpatient care referral, address the paucity of hospital beds, and develop and implement guidelines for the clinical management of seriously ill patients with co-morbidities |
| Improving quality is necessary to building a TB-free world: Lancet Commission on Tuberculosis [18] | Michael J.A. Reid, Eric Goosby | The Lancet Commission on TB states that strategies for improving quality must be hard-wired into the organization of NTPs. It calls for implementation research to understand how to improve care cascades, highlights the compelling economic rationale for ending TB and describes addressing TB as a core component in achieving Universal Health Coverage |
| What quality of care means to tuberculosis survivors [19] | Chapal Mehra, Debshree Lokhande, Deepti Chavan, Saurabh Rane | When high quality care is defined without patients’ perspectives, their needs and expectations are not addressed. High quality care for TB-affected patients is affordable, easily available and accessible, delivered efficiently, and provided in a dignified, empathetic and stigma-free manner |
| Quality of tuberculosis care in the private health sector [20] | Guy Stallworthy, Hannah Monica Dias, Madhukar Pai | In many high TB burden countries, the private healthcare sector manages a large share of all patients. However, quality of TB care in the private sector falls short of international standards in many places and urgently needs improvement |