Reducing delays to Multidrug-Resistant Tuberculosis case detection through a revised routine surveillance system-BMC

Background: Routine surveillance is required to monitor the performance of tuberculosis diagnostic programme and is essential for the rapid detection of drug resistance. The main objective of this study was to explore the effectiveness and stakeholder perception of the current routine surveillance system for previously treated tuberculosis cases in Tanzania with a view to identify interventions to improve and accelerate positive patient outcomes.<b></b>Methods:<b> </b>A study using quantitative and qualitative methods of data collection including in-depth interviews and focus group discussions with health care service providers was conducted in four regions. Quantitative data were extracted from the routine databases to assess performance.Results: Quantitative findings from 2011 to 2013 showed 2,750 specimens from previously treated TB cases were received at the reference laboratory. The number increased year on year, but even in the most recent year was only 61% of that expected. The median and interquartile range of turnaround time in days from specimen reception to results reported for smear microscopy, culture and drug susceptibility testing were 1(1, 1), 61(43, 71) and 129(72, 170) respectively. Contaminated specimens were reported in 3.6% of cases. The qualitative analysis showed the system of sending specimens using postal services was seen to be efficient by participants. However, there were many challenges and significant delays in specimens reaching the reference laboratory associated with lack of funds to transfer specimens, weak form completion, inadequate training and poor supervision. These all adversely affected the implementation of the routine surveillance system.Conclusions: Many issues limit the effectiveness of the routine surveillance system in Tanzania. Priority areas for strengthening are; specimen transportation, supervision and availability of commodities. A pilot study of a revised routine surveillance system that takes into account the observations from this study alongside improved access to drug susceptibility testing using Xpert MTB/RIF should be considered

背景：常规监测是结核病诊断项目绩效监控的必要手段，对快速检出耐药性具有关键意义。本研究旨在评估坦桑尼亚当前针对复治结核病病例（previously treated tuberculosis cases）的常规监测系统的有效性及利益相关方认知，以期识别可优化系统、加速患者正向转归的干预策略。
方法：本研究在四个地区开展，采用定量与定性结合的数据收集方案，包括对医疗服务提供者的深入访谈与焦点小组讨论。研究从常规数据库中提取定量数据，以评估系统运行绩效。
结果：2011至2013年的定量分析结果显示，参考实验室（reference laboratory）共接收复治结核病病例标本2750份，标本量逐年递增，但直至研究覆盖的最晚年份，接收量仅达预期值的61%。涂片显微镜检查（smear microscopy）、培养（culture）及药物敏感性试验（drug susceptibility testing）的标本接收至结果报告的周转时间（turnaround time）中位数及四分位数间距（interquartile range）分别为1(1,1)天、61(43,71)天及129(72,170)天。3.6%的病例存在标本污染情况。定性分析显示，参与人员认为采用邮政服务寄送标本的方式效率尚可，但标本送达参考实验室的过程仍存在诸多挑战与显著延误，诱因包括标本转运资金匮乏、表格填写不规范、培训不足以及监管督导不到位，上述因素均对常规监测系统的落地实施造成了负面影响。
结论：诸多因素制约了坦桑尼亚常规监测系统的运行效能。当前需优先强化的领域包括：标本转运、督导工作及物资供应。建议开展针对优化后常规监测系统的试点研究，该系统需纳入本研究的观测结果，并结合使用Xpert MTB/RIF技术以提升药物敏感性试验的可及性。