Hayibor Kenneth Mawuta, Kenu Ernest, Mensah Gloria Ivy, Awalime Dziedzorm, Anaman Jabina, Asante-Poku Adwoa, Ivanova Olena, Abhishek Bakuli, Rachow Andrea, Hanson-Nortey Nortey Nii
Center for International Health, Ludwig-Maximilians-Universität, Munich, Germany.
Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
Front Public Health. 2025 Aug 26;13:1598269. doi: 10.3389/fpubh.2025.1598269. eCollection 2025.
Although TB services are free in Ghana, TB case detection remains low and mostly limited to public facilities. To address this, a Public-Private Mix (PPM) Directly Observed Therapy (DOT) model was introduced, involving community private healthcare providers and the National Health Insurance Scheme (NHIS) to boost TB case detection rates.
This impact evaluation focuses on four key interventions targeting vulnerable populations in Ghana's two largest metropolitan areas between the last quarter of 2018 and the first quarter of 2020. Screening and TB register data were collected from implementing facilities, along with TB case notifications from 2015 to 2022 for both intervention and control areas. Comparative interrupted time series (ITS) analysis was used to evaluate the effect of the interventions on quarterly TB case notifications.
During the intervention period, a total of 563,868 persons were screened for TB, 12,121 of these were presumptive for TB and 590 persons were diagnosed with TB. Of the diagnosed TB cases, 95.3% (562) were bacteriologically confirmed. The overall TB screening yield was 104.6 cases per 100,000 population. In the intervention area, TB case notifications increased from 1,392 cases in 2018 to 1,462 cases in 2019 while they decreased from 853 to 778 in the control area. The ITS analyses detected positive post-intervention trend differences in all forms of TB and bacteriologically confirmed TB notification case rates between the intervention and control areas.
Expanding free TB services through a PPM DOT model and sustained community engagement can increase TB case detection in urban areas. National TB programs should adopt and scale this approach to enhance TB surveillance and control.
尽管加纳的结核病服务是免费的，但结核病病例发现率仍然很低，而且大多局限于公共设施。为解决这一问题，引入了公私混合（PPM）直接观察治疗（DOT）模式，让社区私立医疗服务提供者和国家健康保险计划（NHIS）参与进来，以提高结核病病例发现率。
这项影响评估聚焦于2018年最后一个季度至2020年第一季度期间针对加纳两个最大都市地区弱势群体的四项关键干预措施。从实施机构收集筛查和结核病登记数据，以及2015年至2022年干预区和对照区的结核病病例通报。采用比较中断时间序列（ITS）分析来评估这些干预措施对季度结核病病例通报的影响。
在干预期间，共有563,868人接受了结核病筛查，其中12,121人疑似患有结核病，590人被诊断为结核病。在确诊的结核病病例中，95.3%（562例）经细菌学确诊。总体结核病筛查检出率为每10万人口104.6例。在干预区，结核病病例通报从2018年的1392例增加到2019年的1462例，而在对照区则从853例降至778例。ITS分析发现，干预区和对照区在所有形式的结核病以及细菌学确诊的结核病通报病例率方面，干预后均存在正向趋势差异。
通过公私混合DOT模式扩大免费结核病服务并持续开展社区参与活动，可以提高城市地区的结核病病例发现率。国家结核病规划应采用并推广这种方法，以加强结核病监测和控制。
