Evidence map›Paper›PMID 39277746›Full record

ArticleArchives of public health = Archives belges de sante publique2024

Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia.

Joseph Mumba Zulu, Patricia Maritim, Hikabasa Halwiindi, Malizgani Paul Chavula, Margarate Munakampe, Tulani Francis L Matenga, Chris Mweemba, Ntazana N Sinyangwe, Batuli Habib, Mwiche Musukuma and 8 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Archives of public health = Archives belges de sante publique, 2024. 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
–field-weighted citation impact
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.

  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

18 authors.

Joseph Mumba ZuluDepartment of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Patricia MaritimDepartment of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Hikabasa HalwiindiDepartment of Community and Family Medicine, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Malizgani Paul ChavulaDepartment of Community and Family Medicine, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia. paul.malizgani@umu.se.
Margarate MunakampeDepartment of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Tulani Francis L MatengaDepartment of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Chris MweembaDepartment of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Ntazana N SinyangweDepartment of Environmental Health, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Batuli HabibDepartment of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Mwiche MusukumaDepartment of Epidemiology and Biostatics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Adam SilumbweDepartment of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Bo WangDepartment of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 N Lake Ave, 01655, Worcester, MA, USA.
Patrick KaongaDepartment of Epidemiology and Biostatics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Mwimba CheweDepartment of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Ronald FisaDepartment of Epidemiology and Biostatics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Jeremiah BandaYakini Health Research Institute, Lusaka, Zambia.
Angel MubangaMinistry of Health, Lusaka, Zambia.
Henry PhiriMinistry of Health, Lusaka, Zambia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDecentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia.

methodsOur qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action.

resultsThe programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members.

conclusionThis study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).

Indexed as

Community health systemsDecentralized programmatic management of multidrug-resistant tuberculosisImplementation strategiesZambia

Identifiers

PMID39277746
PMCPMC11401366

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.