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Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers

Authors :
Lauren A. Rosapep
Sophie Faye
Benjamin Johns
Bolanle Olusola-Faleye
Elaine M. Baruwa
Micah K. Sorum
Flora Nwagagbo
Abdu A. Adamu
Ada Kwan
Christopher Obanubi
Akinyemi Olumuyiwa Atobatele
Source :
PLOS Global Public Health. 2:e0000150
Publication Year :
2022
Publisher :
Public Library of Science (PLoS), 2022.

Abstract

Nigeria has a high burden of tuberculosis (TB) and low case detection rates. Nigeria’s large private health sector footprint represents an untapped resource for combating the disease. To examine the quality of private sector contributions to TB, the USAID-funded Sustaining Health Outcomes through the Private Sector (SHOPS) Plus program evaluated adherence to national standards for management of presumptive and confirmed TB among the clinical facilities, laboratories, pharmacies, and drug shops it trained to deliver TB services. The study used a standardized patient (SP) survey methodology to measure case management protocol adherence among 837 private and 206 public providers in urban Lagos and Kano. It examined two different scenarios: a “textbook” case of presumptive TB and a treatment initiation case where SPs presented as referred patients with confirmed TB diagnoses. Private sector results were benchmarked against public sector results. A bottleneck analysis examined protocol adherence departures at key points along the case management sequence that providers were trained to follow. Except for laboratories, few providers met the criteria for fully correct management of presumptive TB, though more than 70% of providers correctly engaged in TB screening. In the treatment initiation case 18% of clinical providers demonstrated fully correct case management. Private and public providers’ adherence was not significantly different. Bottleneck analysis revealed that the most common deviations from correct management were failure to initiate sputum collection for presumptive patients and failure to conduct sufficiently thorough treatment initiation counseling for confirmed patients. This study found the quality of private providers’ TB case management to be comparable to public providers in Nigeria, as well as to providers in other high burden countries. Findings support continued efforts to include private providers in Nigeria’s national TB program. Though most providers fell short of desired quality, the bottleneck analysis points to specific issues that TB stakeholders can feasibly address with system- and provider-level interventions.

Details

ISSN :
27673375
Volume :
2
Database :
OpenAIRE
Journal :
PLOS Global Public Health
Accession number :
edsair.doi...........94e7def880c8a3b1b217ffab6d110d19
Full Text :
https://doi.org/10.1371/journal.pgph.0000150