Assessment of Training and Mentoring for DR-TB Care Decentralization in Tanzania

Overview

Journal Hum Resour Health

Publisher Biomed Central

Specialty Health Services

Date 2021 Apr 27

PMID 33902587

Citations 3

Authors

Dennis Lyakurwa

Johnson Lyimo

Christiaan Mulder

Puck T Pelzer

Inge Koppelaar

Marleen Heus

Affiliations

Soon will be listed here.

Abstract

Introduction: Drug-resistant TB (DR-TB) care shifted from centralized to decentralized care in Tanzania in 2015. This study explored whether DR-TB training and mentoring supported healthcare workers' (HCWs) DR-TB care performance.

Methods: This mixed study assessed HCWs' DR-TB care knowledge, the training quality, and the mentoring around 454 HCWs who were trained across 55 DR-TB sites between January 2016 and December 2017. Pre- and post-training tests, end-of-training evaluation, supervisor's interviews, DR-TB team self-assessment and team focus group discussion were conducted among trained HCWs. Interim and final treatment results of the national central site and the decentralized sites were compared.

Results: HCW's knowledge increased for 15-20% between pre-training and post-training. HCWs and supervisors perceived mentoring as most appropriate to further develop their DR-TB competencies. Culture negativity after 6 months of treatment was similar for the decentralized sites compared to the national central site, 81% vs 79%, respectively, whereas decentralized sites had less loss to follow-up (0% versus 3%) and fewer deaths (3% versus 12%). Delays in laboratory results, stigma, and HCWs shortage were reported the main challenges of decentralized care.

Conclusions: Training and mentoring to provide DR-TB care at decentralized sites in Tanzania improved HCWs' knowledge and skills in DR-TB care and supported observed good interim and final patient treatment outcomes despite health system challenges.

Citing Articles

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References

Gler M, Podewils L, Munez N, Galipot M, Quelapio M, Tupasi T . Impact of patient and program factors on default during treatment of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2012; 16(7):955-60. PMC: 4616015. DOI: 10.5588/ijtld.11.0502. View

Burlew R, Puckett A, Bailey R, Caffrey M, Brantley S . Assessing the relevance, efficiency, and sustainability of HIV/AIDS in-service training in Nigeria. Hum Resour Health. 2014; 12:20. PMC: 4022275. DOI: 10.1186/1478-4491-12-20. View

Senkoro M, Mfinanga S, Egwaga S, Mtandu R, Kamara D, Basra D . Prevalence of pulmonary tuberculosis in adult population of Tanzania: a national survey, 2012. Int J Tuberc Lung Dis. 2016; 20(8):1014-21. DOI: 10.5588/ijtld.15.0340. View

OMalley G, Perdue T, Petracca F . A framework for outcome-level evaluation of in-service training of health care workers. Hum Resour Health. 2013; 11:50. PMC: 3851191. DOI: 10.1186/1478-4491-11-50. View

Loveday M, Wallengren K, Voce A, Margot B, Reddy T, Master I . Comparing early treatment outcomes of MDR-TB in decentralised and centralised settings in KwaZulu-Natal, South Africa. Int J Tuberc Lung Dis. 2012; 16(2):209-15. PMC: 3281510. DOI: 10.5588/ijtld.11.0401. View

Bluestone J, Johnson P, Fullerton J, Carr C, Alderman J, BonTempo J . Effective in-service training design and delivery: evidence from an integrative literature review. Hum Resour Health. 2013; 11:51. PMC: 3850724. DOI: 10.1186/1478-4491-11-51. View

Huerga H, Bastard M, Kamene M, Wanjala S, Arnold A, Oucho N . Outcomes from the first multidrug-resistant tuberculosis programme in Kenya. Int J Tuberc Lung Dis. 2017; 21(3):314-319. DOI: 10.5588/ijtld.16.0661. View

Molla Y, Jerene D, Jemal I, Nigussie G, Kebede T, Kassie Y . The experience of scaling up a decentralized, ambulatory model of care for management of multidrug-resistant tuberculosis in two regions of Ethiopia. J Clin Tuberc Other Mycobact Dis. 2019; 7:28-33. PMC: 6850264. DOI: 10.1016/j.jctube.2017.03.001. View

Basri C, Bergstrom K, Walton W, Surya A, Voskens J, Metha F . Sustainable scaling up of good quality health worker education for tuberculosis control in Indonesia: a case study. Hum Resour Health. 2009; 7:85. PMC: 2785746. DOI: 10.1186/1478-4491-7-85. View

10.

Bassili A, Fitzpatrick C, Qadeer E, Fatima R, Floyd K, Jaramillo E . A systematic review of the effectiveness of hospital- and ambulatory-based management of multidrug-resistant tuberculosis. Am J Trop Med Hyg. 2013; 89(2):271-80. PMC: 3741248. DOI: 10.4269/ajtmh.13-0004. View

11.

Ho J, Byrne A, Linh N, Jaramillo E, Fox G . Decentralized care for multidrug-resistant tuberculosis: a systematic review and meta-analysis. Bull World Health Organ. 2017; 95(8):584-593. PMC: 5537756. DOI: 10.2471/BLT.17.193375. View

12.

Chen L, Evans T, Anand S, Boufford J, Brown H, Chowdhury M . Human resources for health: overcoming the crisis. Lancet. 2004; 364(9449):1984-90. DOI: 10.1016/S0140-6736(04)17482-5. View

13.

Daru P, Matji R, Jassim AlMossawi H, Chakraborty K, Kak N . Decentralized, Community-Based Treatment for Drug-Resistant Tuberculosis: Bangladesh Program Experience. Glob Health Sci Pract. 2018; 6(3):594-602. PMC: 6172109. DOI: 10.9745/GHSP-D-17-00345. View

14.

Smidt A, Balandin S, Sigafoos J, Reed V . The Kirkpatrick model: A useful tool for evaluating training outcomes. J Intellect Dev Disabil. 2009; 34(3):266-74. DOI: 10.1080/13668250903093125. View

15.

Horter S, Stringer B, Reynolds L, Shoaib M, Kasozi S, Casas E . "Home is where the patient is": a qualitative analysis of a patient-centred model of care for multi-drug resistant tuberculosis. BMC Health Serv Res. 2014; 14:81. PMC: 3943511. DOI: 10.1186/1472-6963-14-81. View

16.

Edginton M . Tuberculosis patient care decentralised to district clinics with community-based directly observed treatment in a rural district of South Africa. Int J Tuberc Lung Dis. 1999; 3(5):445-50. View

17.

Awofeso N, Schelokova I, Dalhatu A . Training of front-line health workers for tuberculosis control: lessons from Nigeria and Kyrgyzstan. Hum Resour Health. 2008; 6:20. PMC: 2569065. DOI: 10.1186/1478-4491-6-20. View