The effects of decentralisation of tuberculosis services in the East New Britain Province, Papua New Guinea

Contexte: Les programmes de lutte contre la tuberculose (TB) du Nonga General Hospital, de la Rabaul Urban Clinic et du Kerevat District Hospital dans la province d'East New Britain Province, Papouasie Nouvelle Guinee. Cadre: En East New Britain, la prise en charge de la TB s'est principalement faite au General Hospital, aboutissant a une prise en charge limitee en communaute et a des resultats mediocres du traitement. A partir de 2016, les services TB ont ete decentralises du niveau provincial au niveau du district grâce a 1) la formation du personnel de sante, 2) la sensibilisation des communautes a la TB, et 3) des strategies avancees hebdomadaires (TACO). Objectif: Decrire l'effet des TACO sur l'utilisation des services de diagnostic et de traitement de TB du 1 janvier 2014 au 31 decembre 2017. Design: This was a retrospective study comparing 2014-2015 (pre-TACO) and 2016-2017 (TACO) cohorts. Results: There was an increase in pre-TACO to TACO cohorts in screened cases (1581 to 2195), total registered TB cases (678 to 824) and registered cases at decentralised sites (209 to 615). Unfavourable treatment outcomes were common (pre-TACO, 46.0% vs. TACO, 40.1%). In multivariable analysis, treatment at a decentralised Basic Management Unit (aOR 0.55, 95%CI 0.42-0.74) was significantly associated with fewer unfavourable outcomes, but treatment outcomes between the pre-TACO and the TACO group were not significantly different. Conclusion: Strengthening decentralisation of TB services at the district level increased TB screening and case registration, with similar treatment outcomes.