Evaluating the Effects of Decentralized District-Based Treatment of Drug-Resistant Tuberculosis in Pakistan: An Alternative Model of Care Decentralized DR-TB Treatment in Pakistan
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Abstract
Background: Pakistan faces a high burden of drug-resistant tuberculosis (DR-TB), with traditional centralized care resulting in delays and poor treatment outcomes. Decentralizing care to district-level hospitals offers a potentially more effective alternative.
Objective: This study aimed to evaluate the impact of decentralized DR-TB care on treatment initiation time, patient follow-up, and treatment outcomes.
Methods: A descriptive post-intervention study was conducted at a decentralized DR-TB clinic in Sheikhupura, Punjab, between June 2021 and December 2022. Data from 100 patients were retrospectively collected from hospital records and diagnostic labs, including demographic information, treatment compliance, smear and culture conversion rates, and adverse drug reactions. SPSS 25 was used for statistical analysis, including descriptive statistics.
Results: The average time from diagnosis to treatment initiation was 14.9 days. Smear conversion by the sixth month was 99%, while culture conversion was 98%. The treatment success rate was 70%, with a 7% loss to follow-up, 2% treatment failure, and 15% mortality.
Conclusion: Decentralized DR-TB care significantly reduced delays in treatment initiation and improved patient outcomes. This model is feasible for national implementation with potential to enhance DR-TB management in Pakistan.
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References
Becker FG, Cleary M, Team RM, Holtermann H. Global Tuberculosis Report 2021. Syria Studies. 2015;7:37–72.
Khan U, Lotia-Farrukh I, Akhtar A, Khowaja SN, Khan S, Madhani F, et al. Re-evaluating the merits of decentralization as a core strategy for effective delivery of drug-resistant tuberculosis care in Pakistan. Health Policy Plan. 2022;37:979–89.
Kielmann K, Dickson-Hall L, Jassat W, le Roux S, Moshabela M, Cox H, et al. Adaptive responses in policy for decentralized drug-resistant tuberculosis care in South Africa. Health Policy Plan. 2021;36(3):249–56.
Daru P, Matji R, AlMossawi HJ, Chakraborty K, Kak N. Decentralized, community-based treatment for drug-resistant tuberculosis: Bangladesh program experience. Glob Health Sci Pract. 2018;6(3):1-12.
Evans D, Sineke T, Schnippel K, Berhanu R, Govathson C, Black A, et al. Impact of Xpert MTB/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa. BMC Health Serv Res. 2018;18(1):762.
NTP Pakistan. DR-TB National Guidelines. 2020;1–125.
Abbas S, Kermode M, Kane S. Strengthening the response to drug-resistant TB in Pakistan: A practice theory-informed approach. Public Health Action. 2021;10(4):147–56.
Aung KJM, van Deun A, Declercq E, Sarker MR, Das PK, Hossain MA, et al. Successful “9-month Bangladesh regimen” for multidrug-resistant tuberculosis among over 500 consecutive patients. Int J Tuberc Lung Dis. 2014;18(10):1180–7.
Cobelens F, van Leth F, Van’T Hoog A. Design of pragmatic trials of tuberculosis interventions. Lancet. 2014;383(9913):213–4.
Mukherjee JS, Rich ML, Socci AR, Joseph JK, Alcántara Virú F, Shin SS, et al. Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet. 2004;363(9407):474–81.
Malla P, Kanitz EE, Akhtar M, Falzon D, Feldmann K, Gunneberg C, et al. Ambulatory-based standardized therapy for multi-drug resistant tuberculosis: Experience from Nepal, 2005–2006. PLoS One. 2009;4(12).
Johnston JC, Shahidi NC, Sadatsafavi M, Fitzgerald JM. Treatment outcomes of multidrug-resistant tuberculosis: A systematic review and meta-analysis. PLoS One. 2009;4(9).
Berhanu R, Schnippel K, Mohr E, Hirasen K, Evans D, Rosen S, et al. Early outcomes of decentralized care for rifampicin-resistant tuberculosis in Johannesburg, South Africa: An observational cohort study. PLoS One. 2016;11(11).
Ullah Khan F, ur Rehman A, Ullah Khan F, Hayat K, Khan A, Ahmad N, et al. Assessment of factors associated with unfavorable outcomes among drug-resistant TB patients: A 6-year retrospective study from Pakistan. Int J Environ Res Public Health. 2022;19(3):1574.