Open AccessRe-evaluating the merits of decentralization as a core strategy for effective delivery of drug-resistant tuberculosis care in Pakistan
Author(s) -
Uzma Khan,
Ismat Lotia-Farrukh,
Ahwaz Akhtar,
Saira Khowaja,
Salman Khan,
Falak Madhani,
Asra Parekh,
Sana Adnan,
Saba Ahmed,
Mariam Chaudhry,
Hamidah Hussain,
Habib Ali,
Shahid Butt,
M. R. Siddiqui,
Raafia Ijaz,
Saba Jamal,
Abdul Bari Khan,
Salmaan Keshavjee,
Aamir Khan,
Naseem Salahuddin,
Palwasha Khan
Publication year - 2022
Publication title -
health policy and planning
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.608
H-Index - 92
eISSN - 1460-2237
pISSN - 0268-1080
DOI - 10.1093/heapol/czac038
Subject(s) - decentralization , tuberculosis , core (optical fiber) , medicine , developing country , business , economic growth , political science , computer science , economics , telecommunications , pathology , law
Decentralized, person-centred models of care delivery for drug-resistant tuberculosis (DR-TB) continue to be under-resourced in high-burden TB countries. The implementation of such models-made increasingly urgent by the COVID-19 pandemic-are key to addressing gaps in DR-TB care. We abstracted data of rifampicin-resistant (RR)/multidrug-resistant tuberculosis (MDR-TB) patients initiated on treatment at 11 facilities between 2010 and 2017 in Sindh and Balochistan provinces of Pakistan. We analysed trends in treatment outcomes relating to programme expansion to peri-urban and rural areas and estimated driving distance from patient residence to treatment facility. Among the 5586 RR/MDR-TB patients in the analysis, overall treatment success decreased from 82% to 66% between 2010 and 2017, as the programme expanded. The adjusted risk ratio for unfavourable outcomes was 1.013 (95% confidence interval 1.005-1.021) for every 20 km of driving distance. Our analysis suggests that expanding DR-TB care to centralized hubs added to increased unfavourable outcomes for people accessing care in peri-urban and rural districts. We propose that as enrolments increase, expanding DR-TB services close to or within affected communities is essential.