| Autor: |
Uzma Khan, Ismat Lotia-Farrukh, Ahwaz Akhtar, Saira N Khowaja, Salman Khan, Falak Madhani, Asra Parekh, Sana Adnan, Saman Ahmed, Mariam Chaudhry, Hamidah Hussain, Ali Habib, Shahid Butt, Muhammad R Siddiqui, Raafia Ijaz, Saba Jamal, Abdul B Khan, Salmaan Keshavjee, Aamir J Khan, Naseem Salahuddin, Palwasha Y Khan |
| Rok vydání: |
2021 |
| Předmět: |
|
| Zdroj: |
Health policy and planning. 37(8) |
| ISSN: |
1460-2237 |
| Popis: |
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models—made increasingly urgent by the COVID-19 pandemic—are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005–1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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