Muhimbili Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania.
School of Nursing and Midwifery, Aga Khan University, Dar Es Salaam, Tanzania.
BMC Infect Dis. 2023 Mar 14;23(1):161. doi: 10.1186/s12879-023-08069-3.
Tuberculosis (TB) remains a major cause of morbidity and mortality, especially in sub-Saharan Africa. We qualitatively evaluated the implementation of an Evidence-Based Multiple Focus Integrated Intensified TB Screening package (EXIT-TB) in the East African region, aimed at increasing TB case detection and number of patients receiving care.
We present the accounts of participants from Tanzania, Kenya, Uganda, and Ethiopia regarding the implementation of EXIT-TB, and suggestions for scaling up.
A qualitative descriptive design was used to gather insights from purposefully selected healthcare workers, community health workers, and other stakeholders. A total of 27, 13, 14, and 19 in-depth interviews were conducted in Tanzania, Kenya, Uganda, and Ethiopia respectively. Data were transcribed and translated simultaneously and then thematically analysed.
The EXIT-TB project was described to contribute to increased TB case detection, improved detection of Multidrug-resistant TB patients, reduced delays and waiting time for diagnosis, raised the index of TB suspicion, and improved decision-making among HCWs. The attributes of TB case detection were: (i) free X-ray screening services; (ii) integrating TB case-finding activities in other clinics such as Reproductive and Child Health clinics (RCH), and diabetic clinics; (iii), engagement of CHWs, policymakers, and ministry level program managers; (iv) enhanced community awareness and linkage of clients; (v) cooperation between HCWs and CHWs, (vi) improved screening infrastructure, (vii) the adoption of the new simplified screening criteria and (viii) training of implementers. The supply-side challenges encountered ranged from disorganized care, limited space, the COVID-19 pandemic, inadequate human resources, inadequate knowledge and expertise, stock out of supplies, delayed maintenance of equipment, to absence of X-ray and GeneXpert machines in some facilities. The demand side challenges ranged from delayed care seeking, inadequate awareness, negative beliefs, fears towards screening, to financial challenges. Suggestions for scaling up ranged from improving service delivery, access to diagnostic equipment and supplies, and infrastructure, to addressing client fears and stigma.
The EXIT-TB package appears to have contributed towards increasing TB case detection and reducing delays in TB treatment in the study settings. Addressing the challenges identified is needed to maximize the impact of the EXIT-TB intervention.
结核病（TB）仍然是发病率和死亡率的主要原因，特别是在撒哈拉以南非洲地区。我们定性评估了在东非地区实施基于证据的多焦点综合强化结核病筛查方案（EXIT-TB）的情况，旨在提高结核病病例检出率和接受治疗的患者人数。
我们展示了来自坦桑尼亚、肯尼亚、乌干达和埃塞俄比亚的参与者对实施 EXIT-TB 的看法，以及扩大规模的建议。
采用定性描述设计，从有目的地选择的医疗保健工作者、社区卫生工作者和其他利益攸关方收集见解。在坦桑尼亚、肯尼亚、乌干达和埃塞俄比亚分别进行了 27、13、14 和 19 次深入访谈。对数据进行了同时转录和翻译，然后进行了主题分析。
EXIT-TB 项目被描述为有助于提高结核病病例检出率、提高耐多药结核病患者的检出率、减少诊断延迟和等待时间、提高 HCWs 的结核病怀疑指数并改善决策。结核病病例检出的属性包括：（i）免费 X 射线筛查服务；（ii）将结核病发现活动整合到其他诊所，如生殖和儿童健康诊所（RCH）和糖尿病诊所；（iii），让社区卫生工作者、政策制定者和部级方案管理人员参与；（iv）提高社区意识和客户联系；（v）HCWs 和社区卫生工作者之间的合作；（vi）改善筛查基础设施；（vii）采用新的简化筛查标准；（viii）对实施者进行培训。遇到的供应方面的挑战包括护理组织混乱、空间有限、COVID-19 大流行、人力资源不足、知识和专业知识不足、供应品短缺、设备维护延迟、以及一些设施缺乏 X 射线和 GeneXpert 机器。需求方面的挑战包括延迟寻求护理、意识不足、对筛查的负面信念和恐惧、经济挑战。扩大规模的建议包括改善服务提供、获得诊断设备和用品以及基础设施、解决客户的恐惧和耻辱感。
EXIT-TB 方案似乎有助于提高研究环境中的结核病病例检出率并减少结核病治疗的延迟。需要解决所确定的挑战，以最大限度地发挥 EXIT-TB 干预措施的影响。
