World Friends Onlus, Nairobi, Kenya.
Health Systems Unit, Tunu Consulting Hub, Nairobi, Kenya.
BMC Public Health. 2024 Jan 10;24(1):144. doi: 10.1186/s12889-023-17631-2.
Tuberculosis related deaths remain a priority globally. Despite advancements in TB care, access to quality care remains inequitable to the disadvantage of those in rural and urban informal settlements. The Awareness, Traditions, and Innovation in combating Tuberculosis (ATI TB) project incorporated active case finding (ACF), use of GeneXpert technology and decentralized services to improve TB care in Kajiado County. This study sought to establish the impact of the project as well as implementation lessons learnt during its tenure in Kajiado County, Kenya.
This evaluation adopted a mixed-methods approach with retrospective cohort analysis for the quantitative data and qualitative data sought through key informant interviews with 28 purposively sampled respondents. The qualitative data was analyzed thematically using Taguette while quantitative data was analyzed using R Software yielding descriptive statistics and measures of association.
While the males were a minority among the presumptive cases (623; 46%), they were the majority (59.3%) among the confirmed TB cases. 70% of the confirmed cases were aged between 15 and 44 years; with those aged between 25- and 34-years being majority (30% of the cases). Majority of the confirmed cases within the project were from rural Kajiado West (79; 66.9%). Though 61% of the presumptive cases were through ACF, only 7% of these tested positive. Conversely, 13% of the self-referrals tested positive. 53% (66) of the positive cases with valid data were self-referrals while ACF accounted for 47% (58) of the positives.
Continued capacity development among health workers, sustained and targeted sensitization and screening among vulnerable groups, strategic collaborations, alongside increased budgetary prioritization of health and TB care by government and partners, and government investments in Social Determinants of Health can ensure gains in TB care are sustained.
结核病相关死亡仍然是全球的一个重点。尽管结核病护理取得了进展，但获得高质量护理的机会仍然不平等，农村和城市非正规住区的人处于不利地位。“结核病防治意识、传统和创新（ATI TB）”项目将主动病例发现（ACF）、GeneXpert 技术的使用和分散服务纳入其中，以改善肯尼亚卡贾多县的结核病护理。本研究旨在确定该项目的影响以及在肯尼亚卡贾多县实施期间获得的经验教训。
本评估采用混合方法，对定量数据进行回顾性队列分析，对 28 名有针对性抽样受访者进行关键知情人访谈，以获取定性数据。使用 Taguette 对定性数据进行主题分析，使用 R 软件对定量数据进行分析，得出描述性统计数据和关联度量。
虽然男性在疑似病例中占少数（623 例，占 46%），但在确诊结核病病例中占多数（59.3%）。70%的确诊病例年龄在 15 至 44 岁之间；25 至 34 岁的人群居多（占病例的 30%）。项目内的大多数确诊病例来自卡贾多西部农村（79 例，占 66.9%）。虽然 61%的疑似病例是通过 ACF 发现的，但只有 7%的病例检测结果呈阳性。相反，13%的自我转诊测试呈阳性。53%（66 例）有有效数据的阳性病例为自我转诊，而 ACF 占阳性病例的 47%（58 例）。
继续对卫生工作者进行能力建设，持续有针对性地对弱势群体进行宣传和筛查，开展战略合作，同时增加政府和合作伙伴对卫生和结核病护理的预算优先排序，以及政府对社会决定因素的投资，可以确保结核病护理的收益得以维持。
