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：常规监测是监测结核病（tuberculosis, TB）诊断项目运行绩效的必要手段，同时也是快速检出耐药性的关键环节。本研究的核心目标为评估坦桑尼亚当前针对复治TB患者的常规监测系统的有效性与利益相关方认知，以期识别可优化并加速患者良好转归的干预措施。 方法：本研究采用定量与定性相结合的数据采集方法，于四个地区开展了面向医疗服务提供者的深入访谈与焦点小组讨论。定量数据源自常规数据库，用于评估系统运行绩效。 结果：2011至2013年的定量分析结果显示，参考实验室共接收复治TB患者标本2750份，且标本量逐年递增，但即便在研究末期，接收量也仅达到预期值的61%。痰涂片镜检、培养及药物敏感性试验（drug susceptibility testing, DST）的标本接收至报告结果的周转天数中位数及四分位间距分别为1(1, 1)、61(43, 71)及129(72, 170)。另有3.6%的标本被检出污染。定性分析结果表明，参与者认为通过邮政系统寄送标本的方式具备效率，但标本送达参考实验室的过程仍存在诸多挑战与显著延迟，具体诱因包括标本转运经费不足、送检表格填写不规范、培训不到位以及监督管理薄弱，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：多项因素制约了坦桑尼亚常规监测系统的运行效能。亟需优先强化的领域包括标本转运、监督管理以及医疗物资供给。建议开展试点研究，对现有常规监测系统进行优化调整，纳入本研究的观测结果，并推广使用Xpert MTB/RIF技术以提升药物敏感性试验的可及性。