International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India.
International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
PLoS One. 2018 Apr 20;13(4):e0196162. doi: 10.1371/journal.pone.0196162. eCollection 2018.
In a study conducted in Bhopal district (a setting with facility for molecular drug susceptibility testing (DST)) located in central India in 2014-15, we found high levels of pre-diagnosis attrition among patients with presumptive multi drug-resistant tuberculosis (MDR-TB)-meaning TB patients who were eligible for DST, were not being tested.
In this study, we explored the health care provider perspectives into barriers and suggested solutions for improving DST.
This was a descriptive qualitative study. One to one interviews (n = 10) and focus group discussions (n = 2) with experienced key informants involved in programmatic management of DR-TB were conducted in April 2017. Manual descriptive thematic analysis was performed.
The key barriers reported were a) lack of or delay in identification of patients eligible for DST because of using treatment register as the source for identifying patients b) lack of assured specimen transport after patient identification and c) lack of tracking. Extra pulmonary TB patients were not getting identified as eligible for DST. Solutions suggested by the health care providers were i) generation of unique identifier at identification in designated microscopy center (DMC), immediate intimation of unique identifier to district and regular monitoring by senior TB laboratory and senior treatment supervisors of patients eligible for DST that were missed; ii) documentation of unique identifier at each step of cascade; iii) use of human carriers/couriers to transport specimen from DMCs especially in rural areas; and iv) routine entry of all presumptive extra-pulmonary TB specimen, as far as possible, in DMC laboratory register.
Lack of assured specimen transport and lack of accountability for tracking patient after identification and referral were the key barriers. The identification of patients eligible for DST among microbiologically confirmed TB at the time of diagnosis and among clinically confirmed TB at the time of treatment initiation is the key. Use of unique identifier at identification and its use to ensure cohort wise tracking has to be complemented with specimen transport support and prompt feedback to the DMC. The study has implications to improve detection of MDR-TB among diagnosed/notified TB patients.
在 2014-15 年于印度中部的博帕尔区（具备分子药敏试验（DST）设施的环境）进行的一项研究中，我们发现疑似耐多药结核病（MDR-TB）患者在诊断前流失率很高-这意味着有资格接受 DST 检测的结核病患者并未接受检测。
在这项研究中，我们探讨了卫生保健提供者对提高 DST 的障碍的看法，并提出了改进方法。
这是一项描述性定性研究。2017 年 4 月，对参与 DR-TB 规划管理的有经验的关键信息员进行了一对一访谈（n=10）和焦点小组讨论（n=2）。采用手动描述性主题分析方法。
报告的主要障碍包括：a）由于使用治疗登记册作为识别患者的来源，导致缺乏或延迟识别有资格接受 DST 的患者；b）在识别患者后，无法保证标本的安全运输；c）缺乏跟踪。肺外结核患者未被确定为有资格接受 DST。卫生保健提供者建议的解决方案包括：i）在指定显微镜检查中心（DMC）识别时生成唯一标识符，立即将唯一标识符通知区，并由高级结核病实验室和高级治疗监督员定期监测有资格接受 DST 但被遗漏的患者；ii）在级联的每一步记录唯一标识符；iii）在农村地区尤其使用人力运输者/快递员从 DMC 运输标本；iv）尽可能在 DMC 实验室登记本中常规输入所有疑似肺外结核标本。
缺乏有保证的标本运输和缺乏对识别和转介后患者的跟踪问责制是主要障碍。在诊断时对微生物学确诊的结核病患者和在治疗开始时对临床确诊的结核病患者中识别有资格接受 DST 的患者是关键。在识别时使用唯一标识符并使用它来确保队列跟踪，必须辅以标本运输支持和及时向 DMC 反馈。该研究对提高诊断/通知结核病患者中 MDR-TB 的检出率具有重要意义。
