SynthesisBMJ global health2020
Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review.
Synthesis in BMJ global health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 1 synthesis or guideline pooled it, 65 citations in OpenAlex.
- Barriers to and enablers of adherence to the treatment of active drug-sensitive tuberculosis in people living with HIV: a mixed method systematic review.BMC public health · 2025Pooled it
- Trial
- Delayed diagnosis of patients with rifampicin-resistant tuberculosis and its associated factors in a high tuberculosis endemic area Guizhou, China.BMC infectious diseases · 2026Article
- Patient-related diagnostic delay and risk of unfavorable treatment outcomes among pulmonary tuberculosis patients at the antituberculosis center of Brazzaville, Republic of Congo.Scientific reports · 2026Article
- Every message counts: scientific analysis of tuberculosis communication materials in Gujarat.BMC public health · 2026Article
- Complementary effects of acid-fast staining, culture, and Xpert MTB/RIFBMC infectious diseases · 2026Article
- Epidemiological Characteristics and Treatment Outcomes of Drug-Resistant Tuberculosis in Limpopo Province, South Africa (2020-2024).Tropical medicine and infectious disease · 2026Article
- Settings, characteristics, and experiences of stigma among people with tuberculosis in Kenya: National survey results.PLOS global public health · 2026Article
- Fifteen years of rifampicin-resistant TB control in Niger: high countrywide treatment uptake and success.IJTLD open · 2026Article
- Severe pre-treatment attrition in the care cascade: clinical outcomes and risk factors among older MDR/RR-TB patients in China.Frontiers in public health · 2026Article
- Retreatment TB is a risk factor for multidrug-resistant TB among people with HIV in rural eastern Uganda: A nested case-control study.Journal of clinical tuberculosis and other mycobacterial diseases · 2025Article
- Barriers to leprosy elimination in Bolivia: Exploring perspectives and experiences of medical professionals and leprosy patients-A phenomenological study.PLoS neglected tropical diseases · 2025Article
- A methodological review of patient healthcare-seeking journeys from symptom onset to receipt of care.BMJ global health · 2025Review
- COVID-19 policies and tuberculosis services in private health sectors of India, Indonesia, and Nigeria.Journal of clinical tuberculosis and other mycobacterial diseases · 2025Article
- Patient pathway analysis of rifampicin-resistant TB diagnostic and treatment delays.IJTLD open · 2025Article
- Factors Associated With Low Tuberculosis Case Detection and Investigation in Public Health Facilities (PHFs) in Bududa District, Uganda: A Cross-Sectional Study.Health science reports · 2025Article
- Impact of diagnosis-related group payment on medical expenditure and treatment efficiency on people with drug-resistant tuberculosis: a quasi-experimental study design.International journal for equity in health · 2025Article
- The burden of tuberculosis and drug resistance in 22 Sub-Saharan African countries, 1990-2021: a GBD 2021 analysis and progress towards WHO 2035 targets with projections to 2050.Frontiers in microbiology · 2025Article
- Article
- Burden and determinants of MDR-TB among prisoners in sub-Saharan Africa: Systematic review and meta-analysis protocol.Journal of public health in Africa · 2025Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDrug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care.
methodsUsing an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019).
resultsOf 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms.
conclusionCase detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.