ArticleBMJ open2021
Tuberculosis care cascade in Zambia - identifying the gaps in order to improve outcomes: a population-based analysis.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies.PLoS medicine · 2024Pooled it
- Trial
- Defining person-centred treatment support for multidrug-resistant TB: a discrete choice experiment.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
- Article
- Importance of confirmatory test characteristics in optimizing community-based screening for tuberculosis: an epidemiological modeling analysis.BMC infectious diseases · 2025Article
- Article
- Clinical impact and cost-effectiveness of the WHO-recommended advanced HIV disease package of care.The Lancet. Global health · 2025Article
- Prevalence and predictors of unsuccessful tuberculosis treatment outcomes among persons with TB/HIV co-infection in Ghana: a 10-year retrospective study.BMC infectious diseases · 2025Article
- Pre-diagnosis and pre-treatment loss to follow-up and associated factors among patients with presumed tuberculosis and those diagnosed in Uganda.BMC health services research · 2024Article
- Individual, community and health systems factors influencing time to notification of tuberculosis: situating software and hardware bottlenecks in local health systems.BMC health services research · 2024Article
- Cost-effectiveness of Low-complexity Screening Tests in Community-based Case-finding for Tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- The in-hospital tuberculosis diagnostic cascade and early clinical outcomes among people living with HIV before and during the COVID-19 pandemic - a prospective multisite cohort study from Ghana.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Article
- A scoping review of patient-centred tuberculosis care interventions: Gaps and opportunities.PLOS global public health · 2023Article
- A qualitative study of factors resulting in care delays for adults with meningitis in Zambia.Transactions of the Royal Society of Tropical Medicine and Hygiene · 2022Article
- Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa.International journal of environmental research and public health · 2021Article
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Authors and funding
11 authors.
Funding
Abstract
objectiveTuberculosis (TB) remains a leading cause of morbidity and mortality in Zambia, especially for people living with HIV (PLHIV). We undertook a care cascade analysis to quantify gaps in care and align programme improvement measures with areas of need.
designRetrospective, population-based analysis.
settingWe derived national-level estimates for each step of the TB care cascade in Zambia. Estimates were informed by WHO incidence estimates, nationally aggregated laboratory and notification registers, and individual-level programme data from four provinces.
participantsParticipants included all individuals with active TB disease in Zambia in 2018. We characterised the overall TB cascade and disaggregated by drug susceptibility results and HIV status.
resultsIn 2018, the total burden of TB in Zambia was estimated to be 72 495 (range, 40 495-111 495) cases. Of these, 43 387 (59.8%) accessed TB testing, 40 176 (55.4%) were diagnosed with TB, 36 431 (50.3%) were started on treatment and 32 700 (45.1%) completed treatment. Among all persons with TB lost at any step along the care cascade (n=39 795), 29 108 (73.1%) were lost prior to accessing diagnostic services, 3211 (8.1%) prior to diagnosis, 3745 (9.4%) prior to initiating treatment and 3731 (9.4%) prior to treatment completion. PLHIV were less likely than HIV-negative individuals to successfully complete the care cascade (42.8% vs 50.2%, p<0.001). Among those with rifampicin-resistant TB, there was substantial attrition at each step of the cascade and only 22.8% were estimated to have successfully completed treatment.
conclusionsLosses throughout the care cascade resulted in a large proportion of individuals with TB not completing treatment. Ongoing health systems strengthening and patient-centred engagement strategies are needed at every step of the care cascade; however, scale-up of active case finding strategies is particularly critical to ensure individuals with TB in the population reach initial stages of care. Additionally, a renewed focus on PLHIV and individuals with drug-resistant TB is urgently needed to improve TB-related outcomes in Zambia.
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