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.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背景：常规监测是监控结核病诊疗项目运行绩效的必要手段，同时也是快速检测耐药性的关键环节。本研究的主要目的为评估坦桑尼亚当前复治结核病患者常规监测系统的运行效果与利益相关方认知，以期识别可用于优化并加速患者获得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收集方法，在四个地区开展研究。其中定性数据收集方式包括对医疗服务提供者的深入访谈与焦点小组讨论；同时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，参比实验室共接收复治结核病例标本2750份，该数量逐年递增，但即便在最后一年，标本量也仅达到预期值的61%。涂片显微镜检查、培养检测及药物敏感性试验的标本接收至结果报告周转时间的中位数及四分位数间距分别为1(1,1)天、61(43,71)天及129(72,170)天。另有3.6%的病例出现标本污染情况。定性分析结果表明，参与调研者认为通过邮政服务寄送标本的方式效率尚可，但标本送达参比实验室的过程仍存在诸多挑战与显著延误，相关诱因包括标本转运资金匮乏、表格填写不规范、培训不足以及监管不力，上述问题均对常规监测系统的落地实施产生了不利影响。 结论：诸多问题限制了坦桑尼亚当前常规监测系统的运行效果，亟需优先强化的领域包括标本运输、监管工作与物资供应。建议结合本研究的观测结果，开展针对修订版常规监测系统的试点研究，并同步推广使用Xpert MTB/RIF技术以提升药物敏感性试验的可及性。