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

Datos Bibliográficos

ID19591702
AutoresLauren Rosapep (0000-0001-8475-9388, Abt Global (United States), autor de correspondencia), Sophie Faye (0000-0003-1861-7079, Abt Global (United States)), Benjamin Johns (0000-0002-2892-6089, Abt Global (United States)), Bolanle Olusola-Faleye (0000-0002-6609-3196, Lagos State Health Service Commission), Elaine M Baruwa (0000-0001-6958-7004, Abt Global (United States)), Micah K Sorum (0000-0002-5304-6788, Abt Global (United States)), Flora Nwagagbo (0000-0003-1328-4287, Lagos State Health Service Commission), Abdu A Adamu (0000-0003-3317-1319), Alistair Kwan (0000-0003-4889-9433, University of California, San Francisco), Christopher Obanubi (University of California, San Francisco), Akinyemi Atobatele (0000-0002-6621-1658, National Agency for the Control of AIDS)
EditoresAndrew D Kerkhoff (0000-0002-5023-6658)
Año2022
Volumen2
Número1
Páginase0000150
Fecha de publicación2022-01-06
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaPLOS Global Public Health (JOURNAL)
Identificadores de la revistaISSN: 2767-3375 • E-ISSN: 2767-3375
EditorialPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0000150
PMID36962145
OpenAlexW4206742358
IdiomaEN
Citas recibidas5
Referencias citadas27

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

Business · Economic growth · Environmental health · Family medicine · Health care · Health facility · Health services · Population · Private sector · Public health · Public sector · Service provider · Tuberculosis · HIV/AIDS Impact and Responses · Medicine · Nursing · Pneumonia and Respiratory Infections · Tuberculosis Research and Epidemiology · Marketing · Pharmacy