Yasobant Sandul, Bhavsar Priya, Kalpana Pachillu, Memon Farjana, Trivedi Poonam, Saxena Deepak
Department of Epidemiology, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, 382042, India.
Center for One Health Education, Research, and Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, 382042, India.
Risk Manag Healthc Policy. 2021 Aug 10;14:3275-3286. doi: 10.2147/RMHP.S322143. eCollection 2021.
Tuberculosis (TB) care cascade is a recently evolved care model for patient retention across the sequential stages of care for a successful treatment outcome. The care cascade is multi-folded and complex in setting where the health system is reforming for its resilience. India, one of the countries with the highest burden of tuberculosis mortality and morbidity, is not an exception to this complexity. With the diverse challenges in the Indian health system and societal diversity, it is essential to understand the factors contributing to this TB care cascade. Thus, this study aims to map all the contributing factors to the TB care cascade in India. Further, it also captures the different patterns of factors explored so far in different countries' regions. This systematic literature review was conducted between October 2020 and February 2021 in India using PubMed databases, Web of Science, and Google Scholar. Two reviewers extracted the data from eligible studies to summarize and tabulate important findings. Data were extracted and tabulated for study design, location of the study, type of TB patients, methodological approach, system side challenges, and demand-side challenges in the study's findings. Out of 692 initial hits from the literature search, 28 studies were finally included to synthesize evidence in this review as per the inclusion and exclusion criteria. This review provides an insight into different factors such as the system-side (health workforce, institutional) and the demand-side (individual, societal) contributing towards the care cascade. The prime factors reflected in most of the studies were socio-economic condition, disease awareness, myths/beliefs, addictions among the demand-side factors and accessibility, the attitude of the healthcare staff, delay in referral for diagnosis among the system-side factors. The accountability for addressing these diverse factors is recommended to close the gaps in the TB care cascade.
结核病治疗连续过程是一种最近发展起来的护理模式，用于在连续的护理阶段留住患者，以实现成功的治疗结果。在卫生系统为提高恢复力而进行改革的背景下，治疗连续过程是多方面且复杂的。印度是结核病死亡率和发病率负担最高的国家之一，也不例外于这种复杂性。鉴于印度卫生系统面临的各种挑战以及社会多样性，了解促成这种结核病治疗连续过程的因素至关重要。因此，本研究旨在梳理出印度结核病治疗连续过程的所有促成因素。此外，它还捕捉了到目前为止在不同国家/地区探索的不同因素模式。本系统文献综述于2020年10月至2021年2月在印度使用PubMed数据库、科学网和谷歌学术进行。两名评审员从符合条件的研究中提取数据，以总结和列表重要发现。针对研究设计、研究地点、结核病患者类型、方法学方法、系统方挑战和研究结果中的需求方挑战提取数据并列表。在文献检索的692条初始命中记录中，最终纳入了28项研究，以根据纳入和排除标准综合本综述中的证据。本综述深入探讨了促成治疗连续过程的不同因素，如系统方（卫生人力、机构）和需求方（个人、社会）因素。大多数研究中反映的主要因素在需求方因素方面是社会经济状况、疾病认知、神话/信仰、成瘾，在系统方因素方面是可及性、医护人员态度、诊断转诊延迟。建议对解决这些不同因素负责，以弥合结核病治疗连续过程中的差距。
