Using Patient-Pathway Analysis to Inform a Differentiated Program Response to Tuberculosis: The Case of Kenya
Using Patient-Pathway Analysis to Inform a Differentiated Program Response to Tuberculosis: The Case of Kenya
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DOI：
10.1093/infdis/jix381
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发表时间：
2017-10-01
影响因子：
6.4
通讯作者：
Osberg, Mike
中科院分区：
文献类型：
--
作者：
Masini, Enos;Hanson, Christy;Osberg, Mike
背景。肯尼亚最近的一项结核病患病率调查发现，该国的结核病患者数量几乎是之前估计的两倍。肯尼亚已优先确定和治疗未通报或失踪的结核病病例。这需要更好地了解患者护理寻求和系统弱点。方法。完成了患者路径分析 (PPA)，以评估患者寻求护理与国家一级以及肯尼亚所有 47 个地方一级县的结核病诊断和治疗服务的可用性之间的一致性。结果。据估计，一半以上的患者在公共部门开始接受护理。在全国范围内，不到一半的患者在开始护理时遇到了结核病诊断和治疗能力。总体而言，各县和机构级别之间的诊断和治疗可用性存在明显差异。讨论。 PPA 结果强调，需要按县采取差异化的结核病护理方法，并且需要更好的转诊系统。大多数肯尼亚人积极寻求护理；提高正规和非正规私营部门以及公共部门的诊断和治疗能力可能有助于查明大多数失踪病例。
Background. A recent tuberculosis prevalence survey in Kenya found that the country is home to nearly twice as many patients with tuberculosis as previously estimated. Kenya has prioritized identifying and treating the unnotified or missing cases of tuberculosis. This requires a better understanding of patient care seeking and system weaknesses.Methods. A patient-pathway analysis (PPA) was completed to assess the alignment between patient care seeking and the availability of tuberculosis diagnostic and treatment services at the national level and for all 47 counties at the subnational level in Kenya.Results. It was estimated that more than half of patients initiate care in the public sector. Nationally, just under half of patients encountered tuberculosis diagnostic and treatment capacity where they initiated care. Overall, there was distinct variation in diagnostic and treatment availability across counties and facility levels.Discussion. The PPA results emphasized the need for a differentiated approach to tuberculosis care, by county, and the distinct need for better referral systems. The majority of Kenyans actively sought care; improving diagnostic and treatment capacity in the formal and informal private sector, as well as in the public sector, could help identify the majority of missing cases.