van der Westhuizen Helene-Mari, Nathavitharana Ruvandhi R, Pillay Clio, Schoeman Ingrid, Ehrlich Rodney
Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care building, Oxford University, OX2 6GG, United Kingdom.
TB Proof, South Africa.
J Clin Tuberc Other Mycobact Dis. 2019 Aug 21;17:100118. doi: 10.1016/j.jctube.2019.100118. eCollection 2019 Dec.
The Lancet Commission on High-Quality Health Systems called for a 'revolution' in the quality of care provided in low- and middle-income countries. We argue that this provides a helpful framework to demonstrate how effective tuberculosis infection prevention and control (TB IPC) implementation should be linked with health system strengthening, moving it from the silo of the national TB programmes. Using this framework, we identify and discuss links between TB IPC implementation and patient safety, human resources for health, prioritising person-centred care, building trust in health systems and refining the tools used to measure TB IPC implementation. Prioritising patient experience has been a recent addition to the definition of high-quality care. In high TB burden settings, the encounter with TB IPC measures may be a TB patient's initial contact with the healthcare system and may cause feelings of stigmatisation. We advocate for re-imagining the way we implement TB IPC, by drawing on the principles of person-centred care through incorporating the experiences of people using healthcare services. Health workers who developed occupational TB also offer a unique perspective: they have both experienced TB IPC and have played a role in implementing it in their workplace. They can be powerful advocates for person-centred TB IPC implementation. Through framing TB IPC as part of health system strengthening and consciously including person-centred perspectives in TB IPC design, measurement and guidelines, we hope to influence future TB IPC research and practice.
《柳叶刀》高质量卫生系统委员会呼吁在低收入和中等收入国家提供的医疗服务质量方面进行一场“革命”。我们认为，这提供了一个有用的框架，以展示有效的结核病感染预防与控制（TB IPC）实施应如何与卫生系统加强相联系，使其从国家结核病规划的孤立状态中脱离出来。利用这个框架，我们确定并讨论了TB IPC实施与患者安全、卫生人力资源、将以人为本的护理放在优先位置、建立对卫生系统的信任以及完善用于衡量TB IPC实施情况的工具之间的联系。将患者体验放在优先位置是最近对高质量护理定义的补充。在结核病负担较高的环境中，接触TB IPC措施可能是结核病患者与医疗保健系统的首次接触，并可能导致污名化感。我们主张通过借鉴以人为本的护理原则，纳入使用医疗服务者的经验，重新构想我们实施TB IPC的方式。患职业性结核病的卫生工作者也提供了一个独特的视角：他们既经历过TB IPC，又在其工作场所参与了TB IPC的实施。他们可以成为以人为本的TB IPC实施的有力倡导者。通过将TB IPC构建为卫生系统加强的一部分，并在TB IPC的设计、衡量和指南中自觉纳入以人为本的观点，我们希望影响未来的TB IPC研究和实践。
