Discipline of Public Health Medicine, University of KwaZulu, Natal, Durban, South Africa.
Department of Health Promotion and Education, Boitekanelo College, Gaborone, Botswana.
Syst Rev. 2023 Aug 3;12(1):135. doi: 10.1186/s13643-023-02296-0.
Tuberculosis is a significant global public health threat, especially in countries with limited resources. To improve tuberculosis care, the World Health Organization emphasizes the importance of considering a TB patient's journey across a variety of connected settings and facilities. A systematic review was conducted to map previously conducted studies to identify existing community TB implementation models, their effectiveness on cost, and treatment outcomes.
Systematic search through various electronic databases MEDLINE, EBSCO (PsycINFO and CINAHL), Cochrane Library, EMBASE, WHO Regional Databases, gray literature, and hand-searched bibliographies was performed. Articles published in English between the years 2000 and 2022 with a substantial focus on community TB implementation models were considered for inclusion. Studies were excluded if the intervention was purely facility-based and those focusing exclusively on qualitative assessments. Two reviewers used standardized methods to screen titles, abstracts, and data charting. Included studies were assessed for quality using ROBINS-I and ROB 2. Analysis of study results uses a PRISMA flow diagram and quantitative approach.
A total of 6982 articles were identified with 36 meeting the eligibility criteria for analysis. Electronic medication monitors showed an increased probability of treatment success rate (RR 1.0-4.33 and the 95% CI 0.98-95.4) in four cohort studies in low- and middle-income countries with the incremental cost-effectiveness of $434. Four cohort studies evaluating community health worker direct observation therapy in low- and middle-income countries showed a treatment success risk ratio of up to 3.09 with a 95% CI of 0.06-7.88. (32,41,43,48) and incremental cost-effectiveness up to USS$410. Moreover, four comparative studies in low- and middle-income countries showed family directly observed treatment success risk ratio up to 9.07, 95% CI of 0.92-89.9. Furthermore, four short message service trials revealed a treatment success risk ratio ranging from 1.0 to 1.45 (95% CI fell within these values) with a cost-effectiveness of up to 350I$ compared to standard of care.
This review illustrates that community-based TB interventions such as electronic medication monitors, community health worker direct observation therapy, family directly observed treatment, and short message service can substantially bolster efficiency and convenience for patients and providers while reducing health system costs and improving clinical outcomes.
结核病是一个重大的全球公共卫生威胁，特别是在资源有限的国家。为了改善结核病护理，世界卫生组织强调考虑结核病患者在各种相关环境和设施中的治疗经历的重要性。本系统综述旨在通过系统检索，绘制已发表的研究，以确定现有的社区结核病实施模式、它们在成本和治疗结果方面的有效性。
通过各种电子数据库（MEDLINE、EBSCO（PsycINFO 和 CINAHL）、Cochrane 图书馆、EMBASE、世界卫生组织区域数据库、灰色文献和手工检索的参考文献）进行系统搜索。纳入的文章必须发表于 2000 年至 2022 年期间，主要关注社区结核病实施模式，且为英文文献。排除仅基于医疗机构的干预措施和仅关注定性评估的研究。两名审查员使用标准化方法筛选标题、摘要和数据图表。使用 ROBINS-I 和 ROB 2 对纳入的研究进行质量评估。使用 PRISMA 流程图和定量方法分析研究结果。
共确定了 6982 篇文章，其中 36 篇符合分析标准。四项在低收入和中等收入国家进行的队列研究显示，电子药物监测器可提高治疗成功率（RR 1.0-4.33，95%CI 0.98-95.4），增量成本效益为 434 美元。四项在低收入和中等收入国家评估社区卫生工作者直接观察治疗的队列研究显示，治疗成功率风险比高达 3.09，95%CI 为 0.06-7.88。（32、41、43、48）和增量成本效益高达 410 美元。此外，四项在低收入和中等收入国家进行的比较研究显示，家庭直接观察治疗的成功率风险比高达 9.07，95%CI 为 0.92-89.9。此外，四项短消息服务试验显示，治疗成功率风险比在 1.0 到 1.45 之间（95%CI 在这些值范围内），成本效益高达 350 美元，与标准护理相比。
本综述表明，基于社区的结核病干预措施，如电子药物监测器、社区卫生工作者直接观察治疗、家庭直接观察治疗和短消息服务，可以极大地提高患者和提供者的效率和便利性，同时降低卫生系统成本并改善临床结果。
