Continuous quality improvement in a community-wide TB screening and prevention programme in Papua New Guinea.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2024-09-01 DOI:10.5588/pha.24.0013

N P Pank, A Aung, G Kama, A Murray, K L Huang, J Greig, M Bauri, G Chan, C Masah, K Kaison, S Umali, T Peter, C Wera, C Velaki, M Ase, I Krangaie, R Viru, T Kurumop, T Keam, S Islam, W Pomat, A Maha, M Boga, M Kal, N Wuatai, S M Graham, S S Majumdar, T Marukutira

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引用次数: 0

Abstract

Setting: Daru Island in Papua New Guinea (PNG) has a high prevalence of TB and multidrug-resistant TB (MDR-TB).

Objective: To evaluate the early implementation of a community-wide project to detect and treat TB disease and infection, outline the decision-making processes, and change the model of care.

Design: A continuous quality improvement (CQI) initiative used a plan-do-study-act (PDSA) framework for prospective implementation. Care cascades were analysed for case detection, treatment, and TB preventive treatment (TPT) initiation.

Results: Of 3,263 people screened for TB between June and December 2023, 13.7% (447/3,263) screened positive (CAD4TB or symptoms), 77.9% (348/447) had Xpert Ultra testing, 6.9% (24/348) were diagnosed with TB and all initiated treatment. For 5-34-year-olds without active TB (n = 1,928), 82.0% (1,581/1,928) had tuberculin skin testing (TST), 96.1% (1,519/1,581) had TST read, 23.0% (350/1,519) were TST-positive, 95.4% (334/350) were TPT eligible, and 78.7% (263/334) initiated TPT. Three PDSA review cycles informed adjustments to the model of care, including CAD4TB threshold and TPT criteria. Key challenges identified were meeting screening targets, sputum unavailability from asymptomatic individuals with high CAD4TB scores, and consumable stock-outs.

Conclusion: CQI improved project implementation by increasing the detection of TB disease and infection and accelerating the pace of screening needed to achieve timely community-wide coverage.

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巴布亚新几内亚全社区结核病筛查和预防计划的持续质量改进。

环境：巴布亚新几内亚（PNG）的达鲁岛（Daru Island）是结核病和耐多药结核病（MDR-TB）的高发区：目的：评估检测和治疗结核病及感染的社区项目的早期实施情况，概述决策过程，并改变医疗模式：设计：一项持续质量改进（CQI）计划采用计划-实施-研究-行动（PDSA）框架进行前瞻性实施。对病例检测、治疗和结核病预防性治疗（TPT）启动的护理流程进行了分析：在 2023 年 6 月至 12 月期间接受结核病筛查的 3263 人中，13.7%（447/3263）筛查结果呈阳性（CAD4TB 或症状），77.9%（348/447）接受了 Xpert Ultra 检测，6.9%（24/348）被确诊为结核病，并全部开始接受治疗。对于没有活动性肺结核的 5-34 岁儿童（n = 1,928），82.0%（1,581/1,928）进行了结核菌素皮试（TST），96.1%（1,519/1,581）读取了 TST，23.0%（350/1,519）TST 阳性，95.4%（334/350）符合 TPT 条件，78.7%（263/334）开始了 TPT 治疗。三个 PDSA 回顾周期对护理模式进行了调整，包括 CAD4TB 临界值和 TPT 标准。发现的主要挑战包括：实现筛查目标、无法从 CAD4TB 得分较高的无症状患者处获得痰液以及耗材缺货：CQI 提高了结核病和感染的检出率，加快了筛查速度，从而及时实现了社区范围内的覆盖。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.

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