The experience of scaling up a decentralized, ambulatory model of care for management of multidrug-resistant tuberculosis in two regions of Ethiopia. (May 2017)

• Record Type: Journal Article
• Authors: Molla, Yohannes; Jerene, Degu; Jemal, Ilili; Nigussie, Gebrie; Kebede, Tenagne; Kassie, Yewulsew; Hiruy, Nebiyu; Aschale, Getachew; Habte, Dereje; Gashu, Zewdu; Haile, Yared Kebede; Melese, Muluken; Suarez, Pedro
• Is Part Of: Journal of clinical tuberculosis and other mycobacterial diseases. Volume 7(2017)
• Page Start: 28
• Page End: 33
• Publication Date: 2017-05
• Subjects: Tuberculosis -- Periodicals; Mycobacterial diseases -- Periodicals; 616.995
• DOI: 10.1016/j.jctube.2017.03.001
• Languages: English
• ISSNs: 2405-5794

Abstract

Abstract: Strong strategies, including proven service delivery models, are needed to address the growing global threat of multidrug-resistant tuberculosis (MDR-TB) in low- and middle-income settings. The objective of this study was to assess the feasibility and effectiveness of the nationally approved ambulatory service delivery model for MDR-TB treatment in two regions of Ethiopia. We used routinely reported data to describe the process and outcomes of implementing an ambulatory model for MDR-TB services in a resource-limited setting. We compared percentage improvements in the number of MDR-TB diagnostic and treatment facilities, number of MDR-TB sputum samples processed per year, and MDR-TB cases ever enrolled in care between baseline and 2015. We also calculated interim and final treatment outcomes for patients who had completed at least 12 and 24 months of follow-up, respectively. Between 2012 and 2015, the number of MDR-TB treatment-initiating centers increased from 1 to 23. The number of sputum samples tested for MDR-TB increased 20-fold, from 662 to 14, 361 per year. The backlog of patients on waiting lists was cleared. The cumulative number of MDR-TB patients put on treatment increased from 56 to 790, and the treatment success rate was 75%. Rapid expansion of the ambulatory model of MDR-TB care was feasible and achieved a high treatment success rate in two regions of Ethiopia. More effort is needed to sustain the gains and further decentralize services to the community level.