Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives.
Factors contributing to pre-treatment loss to follow-up in adults with pulmonary tuberculosis: a qualitative evidence synthesis of patient and healthcare worker perspectives.
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DOI：
10.1080/16549716.2022.2148355
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发表时间：
2023-12-31
影响因子：
2.6
通讯作者：
Steingart, Karen R.
中科院分区：
文献类型：
--
作者：
Mulaku, Mercy Namuma;Nyagol, Bruce;Owino, Eddy Johnson;Ochodo, Eleanor;Young, Taryn;Steingart, Karen R.
关键词：
自2018年以来，全球已有超过1400万人接受结核病治疗。然而，治疗前失访（PTLFU）已被证明在结核病护理级联中对患者损失有很大贡献，随后具有较高的社区传播率和死亡率。识别、评价和综合患者和医护人员对导致肺结核成人PTLFU因素的观点的证据。我们在PROSPERO注册了标题（CRD 42021253212）。我们检索了截至2021年5月24日的9个相关数据库以进行定性研究。两名综述作者独立审查了记录的合格性和提取的数据。我们使用政策和实践信息中心工具的证据评估了方法学质量，并使用支持使用研究证据框架合成了数据。我们使用定性研究评论证据的信心（GRADE-CERQual）评估了我们发现的信心。我们共审查了1239份记录，包括5项研究，均来自低收入和中等收入国家。患者和医护人员报告的关键主题是医护人员之间以及医护人员与患者之间的沟通挑战;有关结核病及其管理的知识、态度和行为;结核病护理设施的可及性和可用性;以及人力资源和财政限制、结核病规划管理和领导能力薄弱。病人改变住所、等待时间长和转诊系统差是导致病人脱离护理的其他因素。我们对我们的大部分发现都有适度的信心。我们的定性证据综合结果突出了导致PTLFU的多种因素。解决这些因素的核心是需要加强卫生系统，提供以人为本的护理。
Since 2018, over 14 million people have been treated for tuberculosis (TB) globally. However, pre-treatment loss to follow-up (PTLFU) has been shown to contribute substantially to patient losses in the TB care cascade with subsequent high community transmission and mortality rates. To identify, appraise, and synthesise evidence on the perspectives of patients and healthcare workers on factors contributing to PTLFU in adults with pulmonary TB. We registered the title with PROSPERO (CRD42021253212). We searched nine relevant databases up to 24 May 2021 for qualitative studies. Two review authors independently reviewed records for eligibility and extracted data. We assessed methodological quality with the Evidence for Policy and Practice Information Centre tool and synthesised data using the Supporting the Use of Research Evidence framework. We assessed confidence in our findings using Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual). We reviewed a total of 1239 records and included five studies, all from low- and middle-income countries. Key themes reported by patients and healthcare workers were communication challenges among healthcare workers and between healthcare workers and patients; knowledge, attitudes, and behaviours about TB and its management; accessibility and availability of facilities for TB care; and human resource and financial constraints, weakness in management and leadership in TB programmes. Patients’ change of residence, long waiting times, and poor referral systems were additional factors that contributed to patients disengaging from care. We had moderate confidence in most of our findings. Findings from our qualitative evidence synthesis highlight multiple factors that contribute to PTLFU. Central to addressing these factors will be the need to strengthen health systems and offer people-centred care.
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