Polanco-Pasaje Jhon Edwin, Rodríguez-Márquez Iader, Tello-Hoyos Kelly Yoana, Torres-Pereda Pilar, Guzmán-Salazar Bertha Leonor, Pérez Freddy
Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia Medellín Colombia Grupo de Investigación Epidemiología, Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia.
Secretaría de Salud Departamental Gobernación del Cauca Colombia Secretaría de Salud Departamental, Gobernación del Cauca, Colombia.
Rev Panam Salud Publica. 2020 Dec 17;44:e150. doi: 10.26633/RPSP.2020.150. eCollection 2020.
Construct and evaluate the care cascade for pulmonary tuberculosis in the indigenous population of the department of Cauca (Colombia) and identify existing gaps.
Mixed-methods sequential explanatory design. In the first phase, the pulmonary tuberculosis care cascade for the indigenous population of Cauca was evaluated. Data were obtained from secondary sources and all cases diagnosed from 1 January 2016 to 31 December 2017 were included. In the second phase, semi-structured interviews were done with nine program coordinators and 11 nursing auxiliaries to explain identified gaps. Absolute and percentage values were estimated for each of the steps and gaps in the care cascade. Quantitative and qualitative results were triangulated.
In 2016 and 2017, an estimated 202 patients with respiratory symptoms were expected to be positive and 106 cases of pulmonary tuberculosis were reported among the indigenous population of the department of Cauca. A gap of 47.5% was found for diagnosis, since only 52.5% of subjects were diagnosed in health services. This gap was explained by poor quality of samples and flawed smear techniques; flaws in correct identification of patients with respiratory symptoms; limited access to diagnostic methods, such as culture and molecular tests; and limited training and high turnover of personnel in health service provider institutions.
The tuberculosis control program should focus actions on bridging the gap in case detection in the indigenous population.
构建并评估考卡省（哥伦比亚）原住民肺结核的治疗流程，并找出存在的差距。
采用混合方法的序列解释性设计。在第一阶段，对考卡省原住民的肺结核治疗流程进行评估。数据来自二手资料，纳入了2016年1月1日至2017年12月31日期间诊断的所有病例。在第二阶段，对9名项目协调员和11名护理辅助人员进行了半结构化访谈，以解释所发现的差距。对治疗流程中的每个步骤和差距估计了绝对值和百分比值。对定量和定性结果进行了三角验证。
2016年和2017年，考卡省原住民中预计有202例呼吸道症状患者呈阳性，报告了106例肺结核病例。诊断方面存在47.5%的差距，因为只有52.5%的受试者在卫生服务机构得到诊断。造成这一差距的原因包括样本质量差和涂片技术有缺陷；对呼吸道症状患者的正确识别存在缺陷；获得培养和分子检测等诊断方法的机会有限；以及卫生服务提供机构人员培训有限且人员流动率高。
结核病控制项目应将行动重点放在弥合原住民病例发现方面的差距上。
