Solutions to improve the latent tuberculosis Cascade of Care in Ghana: a longitudinal impact assessment.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Health Impact Assessment/*methods ; Latent Tuberculosis/*epidemiology ; Latent Tuberculosis/*therapy; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child, Preschool ; Family Characteristics ; Female ; Ghana/epidemiology ; Health Knowledge, Attitudes, Practice ; Health Personnel/psychology ; Humans ; Infant ; Knowledge ; Latent Tuberculosis/economics ; Latent Tuberculosis/psychology ; Longitudinal Studies ; Male ; Middle Aged ; Non-Randomized Controlled Trials as Topic ; Outpatients/psychology ; Patient Acceptance of Health Care/psychology ; Surveys and Questionnaires ; Young Adult

Background: Loss of patients in the latent tuberculosis infection (LTBI) cascade of care is a major barrier to LTBI management. We evaluated the impact and acceptability of local solutions implemented to strengthen LTBI management of household contacts (HHCs) at an outpatient clinic in Ghana.
Methods: Local solutions to improve LTBI management were informed by a baseline evaluation of the LTBI cascade and questionnaires administered to index patients, HHCs, and health care workers at the study site in Offinso, Ghana. Solutions aimed to reduce patient costs and improve knowledge. We evaluated the impact and acceptability of the solutions. Specific objectives were to: 1) Compare the proportion of eligible HHCs completing each step in the LTBI cascade of care before and after solution implementation; 2) Compare knowledge, attitude, and practices (KAP) before and after solution implementation, based on responses of patients and health care workers (HCW) to structured questionnaires; 3) Evaluate patient and HCW acceptability of solutions using information obtained from these questionnaires.
Results: Pre and Post-Solution LTBI Cascades included 58 and 125 HHCs, respectively. Before implementation, 39% of expected < 5-year-old HHCs and 66% of ≥5-year-old HHCs were identified. None completed any further cascade steps. Post implementation, the proportion of eligible HHCs who completed identification, assessment, evaluation, and treatment initiation increased for HHCs < 5 to 94, 100, 82, 100%, respectively, and for HHCs ≥5 to 96, 69, 67, 100%, respectively. Pre and Post-Solutions questionnaires were completed by 80 and 95 respondents, respectively. Study participants most frequently mentioned financial support and education as the solutions that supported LTBI management.
Conclusion: Implementation of locally selected solutions was associated with an increase in the proportion of HHCs completing all steps in the LTBI cascade. Tuberculosis programs should consider prioritizing financial support, such as payment for chest x-rays, to support LTBI cascade completion.

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143350 Canada CAPMC CIHR

Keywords: Cascade of care; End TB strategy; Improvement; LTBI

Date Created: 20200520 Date Completed: 20200706 Latest Revision: 20200706

20240105

PMC7236456

10.1186/s12879-020-05060-0

32423422