Rapid Improvement in Passive Tuberculosis Case Detection and Tuberculosis Treatment Outcomes After Implementation of a Bundled Laboratory Diagnostic and On-Site Training Intervention Targeting Mid-Level Providers

摘要: Background.  Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the system each year. We assessed impact of improved TB diagnostics and on-site training on case detection treatment outcomes in rural healthcare facilities. Methods.  Fluorescence microscopy, Xpert MTB/RIF, were introduced at 10 Using quasi-experimental methods, these intervention facilities compared 2 controls their own performance previous Results.  From January to October 2012, 186 357 32 886 outpatients seen facilities, respectively. The had 52.04% higher proportion presumptive sputum examination (odds ratio [OR] = 12.65; 95% confidence interval [CI], 5.60-28.55). After adjusting for age group gender, smear-positive patients initiated was 37.76% than (adjusted OR [AOR], 7.59; CI, 2.19-26.33). factors above, as well human immunodeficiency virus retreatment status, who completed 29.16% (AOR, 4.89; 2.24-10.67) lost follow-up 66.98% lower 0.04; 0.01-0.09). When baseline performance, significantly (64.70% vs 3.44%; OR, 23.95; 12.96-44.25), started 56.25% more during project period 15.36; 6.57-35.91). Conclusions.  Optimizing existing workforce through bundled nonphysician workers will rapidly improve towards global targets.