Decentralising drug-resistant TB treatment initiation services

Area of Science:

• Public Health
• Infectious Disease Management
• Healthcare Systems Research

Background:

• Centralized drug-resistant tuberculosis (DR-TB) care in Nigeria leads to significant pre-treatment loss-to-follow-up (PTLTFU) and delays in starting treatment.
• Effective coordination of DR-TB services is crucial for improving patient outcomes and reducing treatment attrition.

Purpose of the Study:

• To evaluate the impact of decentralizing DR-TB services on treatment enrollment and time-to-treatment initiation in Southern Nigeria.
• To assess the effectiveness of a multi-faceted intervention aimed at improving DR-TB care coordination through decentralization.

Main Methods:

• A quasi-experimental study design was employed in Southern Nigeria over a 15-month period.
• A multi-level intervention comprising eight components was implemented in intervention states.
• Data were collected via desk review proformas and analyzed to compare outcomes between intervention and control states.

Main Results:

• Decentralization significantly increased treatment enrollment for DR-TB patients in intervention states (79.1%) compared to control states (66.0%).
• Pre-treatment loss-to-follow-up (PTLTFU) substantially decreased in intervention states (from 39.5% to 20.9%) but increased in control states.
• The median time-to-treatment initiation decreased post-intervention in both intervention (17 to 14 days) and control states (21 to 15 days), with a more pronounced reduction in intervention states.

Conclusions:

• Decentralizing DR-TB services is an effective strategy for reducing the diagnosis-enrolment gap and accelerating treatment initiation.
• The findings support the expansion of decentralized DR-TB care models within Nigeria's healthcare system.