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Establishing the cascade of care for patients with tuberculous meningitis
Darma Imran1, Philip C Hill2, Jacob McKnight3
1Department of Neurology, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia.
Abstract:
Meningitis is a relatively rare form of tuberculosis, but it carries a high mortality rate, reaching 50% in some settings, with higher rates among patients with HIV co-infection and those with drug-resistant disease. Most studies of tuberculosis meningitis (TBM) tend to focus on better diagnosis, drug treatment and supportive care for patients in hospital. However, there is significant variability in mortality between settings, which may be due to specific variation in the availability and quality of health care services, both prior to, during, and after hospitalization. Such variations have not been studied thoroughly, and we therefore present a theoretical framework that may help to identify where efforts should be focused in providing optimal services for TBM patients. As a first step, we propose an adjusted cascade of care for TBM and patient pathway studies that might help identify factors that account for losses and delays across the cascade. Many of the possible gaps in the TBM cascade are related to health systems factors; we have selected nine domains and provide relevant examples of systems factors for TBM for each of these domains that could be the basis for a health needs assessment to address such gaps. Finally, we suggest some immediate action that could be taken to help make improvements in services. Our theoretical framework will hopefully lead to more health system research and improved care for patients suffering from this most dangerous form of tuberculosis.
Insights
Tuberculosis meningitis (TBM) has a high mortality rate, especially with HIV or drug resistance. This study proposes a health systems framework and cascade of care to identify gaps and improve services for TBM patients globally.
Area of Science:
- Infectious Diseases
- Public Health
- Health Systems Research
Background:
- Tuberculosis meningitis (TBM) is a severe form of tuberculosis with high mortality rates, particularly in HIV-coinfected and drug-resistant cases.
- Existing research often focuses on clinical management within hospitals, overlooking variations in healthcare services that impact TBM outcomes.
- Significant mortality disparities exist between different settings, suggesting a crucial role for health system factors.
Purpose of the Study:
- To present a theoretical framework for analyzing health system factors influencing Tuberculosis meningitis (TBM) patient outcomes.
- To propose an adjusted cascade of care model tailored for TBM patient pathways.
- To identify critical gaps and delays in TBM care attributable to health system weaknesses.
Main Methods:
- Development of a theoretical framework focusing on health systems factors.
- Proposal of an adjusted cascade of care model for TBM.
- Identification of nine key health system domains with relevant examples for TBM.
Main Results:
- The study outlines a framework to assess health system variations affecting TBM mortality.
- An adjusted cascade of care is proposed to pinpoint losses and delays in patient pathways.
- Nine health system domains are identified as crucial for TBM care needs assessment.
Conclusions:
- Addressing health system gaps is essential for improving Tuberculosis meningitis (TBM) outcomes.
- The proposed framework and cascade of care can guide research and interventions.
- Further health system research is needed to optimize TBM patient services and reduce mortality.
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