Making it happen - Increasing access to diagnosis and treatment for tuberculosis

实现这一目标——增加结核病诊断和治疗的机会

• 批准号: ES/L007746/1
• 负责人: Luis Cuevas
• 金额: $ 10.51万
• 依托单位: Liverpool School of Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2014
• 资助国家: 英国
• 起止时间: 2014 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FL007746%2F1
• 关键词: Making; happen; Increasing; access; diagnosis

One third of 8.7 million cases of tuberculosis (TB) occurring each year are missed by health services and there is a need to increase case identification worldwide. In Ethiopia, TB is one of the major causes of adult death, affecting the lives of many people and health service coverage is poor, resulting in low case detection. Recently, proactive approaches canvassing the community to identify individuals through house-to-house visits combined with health education have been shown to increase TB case detection. We have shown that village-based health extension workers (HEW) in Ethiopia increase the accessibility to diagnosis and treatment in the Southern Region. HEWs are part of the Ethiopian Health Service Extension Programme (HSEP), which aims to improve access to health services by providing basic health packages at community level. In the new TB package, HEWs identify individuals with symptoms suggestive of TB, collect and prepare tests from sputum and supervisors with motorbikes link the HEWs to the diagnostic laboratories and treatment is provided and supervised at home or at the local health post. The package has doubled the number of cases identified and increased treatment completion, confirming that bridging the gap between services and the community is crucial to increase uptake. The approach has considerable support by health providers and donors and has generated interest for adoption by the HSEP. However, moving from an independent-project to a package integrated within the system is a process that requires many steps for adoption. Clearly there is a need to have a process to formalise the debate to consider the adoption of a community-based TB package and we therefore propose to:1. Engage health and financial policy decision makers at district, regional, national and international level to discuss the process of policy development in Ethiopia,2. Engage policy makers and programme managers to set objectives and agreeing monitoring and impact assessment needs for the TB package and 3. Document the process considering the implementation of the package within the HSEP as a case study. Methods: The process will start by preparing packages of documentation describing concepts and research findings; systematic reviews available; summaries of findings presented in ways accessible to political, health service and user audiences and users; descriptions of mechanisms to guide policy change and discussion guides with issues that need debate. We will organise a variety of discussion platforms of all stakeholders including focus groups discussions (FGDs) and in depth interviews (IDIs) with Ministry of Health (MoH), beneficiaries and programme implementers to highlight barriers to accessing diagnosis and treatment; staff from the Health Bureau and the department of finance and economic development to discuss the package, its advantages, disadvantages and costs; barriers, enablers and implementation modalities of best practice that could be useful to the community and IDIs with high level policy makers, the WHO and funders to discuss policy formulation. The process will culminate in a national meeting to discuss the package and eventual policy development.Learning by doingThe barriers for accessing services are not specific to TB and similar approaches are needed for other health problems and Ethiopia is desperately looking for interventions to improve health service delivery for rural communities. The process of adopting a new package could be used to build capacity to review and develop policies and as a knowledge transfer platform for similar packages within the HSEP. The process proposed would be a catalyst for capacity building in decision making, the use of research evidence for policy guidance and a case study on how evidence can inform policy development in a Sub-Saharan country.

在每年发生的870万例结核病病例中，有三分之一被卫生服务部门漏诊，需要在全世界增加病例识别。在埃塞俄比亚，结核病是成人死亡的主要原因之一，影响许多人的生活，卫生服务覆盖率低，导致病例发现率低。最近，通过逐户访问结合健康教育对社区进行积极游说以确定个人的做法已被证明可以提高结核病病例的发现率。我们已经表明，埃塞俄比亚以村庄为基础的卫生推广工作者增加了南部地区获得诊断和治疗的机会。卫生保健工作者是埃塞俄比亚卫生服务推广方案的一部分，该方案旨在通过在社区一级提供基本保健包，改善获得卫生服务的机会。在新的结核病一揽子计划中，卫生保健工作者确定有结核病症状的个人，收集和准备痰液测试，监督员骑摩托车将卫生保健工作者与诊断实验室联系起来，在家中或当地卫生站提供治疗并进行监督。该一揽子计划使查明的病例数量增加了一倍，并提高了治疗完成率，证实弥合服务与社区之间的差距对提高接受率至关重要。这一方法得到了卫生服务提供者和捐助者的大力支持，并引起了卫生部门方案采用这一方法的兴趣。然而，从一个独立的项目到一个集成在系统中的包是一个需要许多步骤来采用的过程。显然，需要有一个程序来正式讨论考虑采用以社区为基础的结核病一揽子计划，因此，我们建议：1。在地区、区域、国家和国际各级动员卫生和财政政策决策者讨论哥伦比亚的政策制定进程。让决策者和方案管理人员参与制定目标，并商定结核病一揽子计划的监测和影响评估需求;将HSEP中的软件包实施过程作为案例研究进行记录。研究方法：这一进程将首先编写一套文件，说明概念和研究结果;提供系统的审查;以便于政治、保健服务和用户受众和用户了解的方式介绍研究结果的摘要;说明指导政策变化的机制和讨论需要辩论的问题的指南。我们将为所有利益相关者组织各种讨论平台，包括与卫生部、受益人和方案实施者进行焦点小组讨论和深入访谈，以强调获得诊断和治疗的障碍;卫生局和财政和经济发展部的工作人员讨论一揽子计划及其优点、缺点和成本;与高层决策者、世卫组织和资助者讨论政策制定的最佳做法的障碍、推动因素和实施方式，这些做法可能对社区和IDIs有用。这一进程将在一次全国会议上达到高潮，讨论一揽子计划和最终的政策制定。在实践中学习获得服务的障碍并不是结核病特有的，其他健康问题也需要类似的方法，埃塞俄比亚正在迫切寻找干预措施，以改善农村社区的卫生服务提供。通过新的一揽子计划的过程可用于建设审查和制定政策的能力，并可作为卫生部门改革方案内类似一揽子计划的知识转让平台。拟议的进程将成为决策能力建设的催化剂，将研究证据用于政策指导，并就证据如何为撒哈拉以南国家的政策制定提供信息进行案例研究。

项目成果

Patients direct costs to undergo TB diagnosis.

• DOI: 10.1186/s40249-016-0117-x
• 发表时间: 2016-03-24
• 期刊: Infectious diseases of poverty
• 影响因子: 8.1
• 作者: de Cuevas RM;Lawson L;Al-Sonboli N;Al-Aghbari N;Arbide I;Sherchand JB;Nnamdi EE;Aseffa A;Yassin MA;Abdurrahman ST;Obasanya J;Olanrewaju O;Datiko D;Theobald SJ;Ramsay A;Squire SB;Cuevas LE
• 通讯作者: Cuevas LE

Exploring providers' perspectives of a community based TB approach in Southern Ethiopia: implication for community based approaches.

探索埃塞俄比亚南部社区结核病方法的提供者的观点：对基于社区的方法的影响。

• DOI: 10.1186/s12913-015-1149-9
• 发表时间: 2015-11-09
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: Datiko DG;Yassin MA;Tulloch O;Asnake G;Tesema T;Jamal H;Markos P;Cuevas LE;Theobald S
• 通讯作者: Theobald S

Barriers to completing TB diagnosis in Yemen: services should respond to patients' needs.

• DOI: 10.1371/journal.pone.0105194
• 发表时间: 2014
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Anderson de Cuevas RM;Al-Sonboli N;Al-Aghbari N;Yassin MA;Cuevas LE;Theobald SJ
• 通讯作者: Theobald SJ

Patient and community experiences of tuberculosis diagnosis and care within a community-based intervention in Ethiopia: a qualitative study.

• DOI: 10.1186/s12889-015-1523-x
• 发表时间: 2015-02-25
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Tulloch O;Theobald S;Morishita F;Datiko DG;Asnake G;Tesema T;Jamal H;Markos P;Cuevas LE;Yassin MA
• 通讯作者: Yassin MA