Evidence map›Paper›PMID 32957966›Full record

ArticleBMC health services research2020

Preparedness of outpatient health facilities for ambulatory treatment with all-oral short DR-TB treatment regimens in Zhytomyr, Ukraine: a cross-sectional study.

Tinne Gils, Chinmay Laxmeshwar, Marve Duka, Khachatur Malakyan, Olga Valentinovna Siomak, Vitaly Stephanovich Didik, Natalia Lytvynenko, Yana Terleeva, Dmytri Donchuk, Petros Isaakidis

Open access · goldAbstract read
In one paragraph

Article in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.1field-weighted citation impact, top 52% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 5 institutions in 2 countries.

Tinne GilsMédecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine. tinnegils@gmail.com.ORCID http://orcid.org/0000-0002-5518-9600
Chinmay LaxmeshwarMédecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine.
Marve DukaMédecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine.
Khachatur MalakyanMédecins Sans Frontières, 64 Berdychivska St., Huiva, Zhytomyr, Oblast, Ukraine.
Olga Valentinovna SiomakZhytomyr Regional Tuberculosis Dispensary, Zhytomyr, Ukraine.
Vitaly Stephanovich DidikZhytomyr Regional Tuberculosis Dispensary, Zhytomyr, Ukraine.
Natalia LytvynenkoNational Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
Yana TerleevaDepartment of Tuberculosis Programme Coordination, Public Health Centre of the Ministry of Health of Ukraine, Kyiv, Ukraine.
Dmytri DonchukSouthern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa.
Petros IsaakidisSouthern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa.
Médecins Sans Frontières · ZAPolissia National University · UAMinistry of Health · UANational Academy of Medical Sciences of Ukraine · UAZhytomyr Polytechnic State University · UA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundUkraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care.

methodsThis is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support.

resultsWe visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support.

conclusionOutpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.

Indexed as

Ambulatory CareAmbulatory Care FacilitiesCross-Sectional StudiesHumansInfection ControlOutpatientsPrimary Health CareRetrospective StudiesSurveys and QuestionnairesTuberculosis, Multidrug-ResistantTuberculosis, PulmonaryUkraineAnti-microbial resistanceDR-TBDR-TB health systemOutpatient carePatient-centred careQuality of care

Identifiers

PMID32957966
PMCPMC7507621
OpenAlexW3087113648

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.