Routine surveillance for the identification of drug resistant Tuberculosis in Tanzania: A cross Sectional study of stakeholder’s perceptions

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.

Methods: 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