Ending the Tuberculosis Epidemic Page: 7 of 19
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IMPROVING ACCESS
TO HIGH QUALITY
PATIENT-CENTERED
TB SERVICES
With USAID support, countries with a high burden of
TB are expanding access to high-qualityTB services,
includingTB and MDR-TB diagnosis, treatment, care,
and prevention. In FY 20I5, over 3.7 million TB
cases were notified to national TB programs in
the 23 countries with USAID bilateral TB funding and
more than 2.8 million people successfully
completed treatment.USAID is working with country partners to
expand access toTB services by improving enabling
environments, strengthening diagnostic networks, and
supporting patient-centered TB care.
ENABLING ENVIRONMENTS
People suffering from TB face many challenges in
accessingTB services including cost, distance, and
stigma and discrimination. In 20I5, USAID worked
with country partners to create positive enabling
environments, supporting efforts to increase the
availability and affordability ofTB services and combat
TB-related stigma and discrimination, particularly in
areas serving high-risk populations.In the Philippines, USAID is assisting people living
in isolated, rural villages with getting screened and
tested forTB by working with partners to establish
remote "smearing stations" in 249 locations around
the country.These stations collect and prepare sputum
samples from patients with TB symptoms and send
the samples to rural health facilities for examination
and diagnosis.This program has expanded access to
TB services in the Philippines, facilitating the diagnosis
and treatment ofTB patients in rural areas.
PATIENT-CENTERED CARE
TB prevention practices, diagnostic processes, and
treatment regimens are highly effective when followed
correctly. However, strict adherence can be time-
consuming, inconvenient, and expensive, all of which
reduce patient adherence.To improve TB outcomes,
USAID is working with National TB Programs to
develop and implement patient-centered TB services.
Patient centered care is defined by the Institute of
Medicine as "care that is respectful of and responsive
to individual patient preferences, needs, and values
and [ensures] that patient values guide all clinical
decisions."6 In the context ofTB, patient-centered care
focuses on the patient's right to actively participate
as a fully informed partner in decisions and activities
related to theirTB diagnosis and treatment. Patient-
centered care models forge a partnership between
patient and provider; resulting in the best quality of
care based on individual needs, increasing treatment
adherence and ultimately leading to better treatment
outcomes.In Ukraine, USAID is working to improve MDR-TB
treatment outcomes by supporting patient-centered
models of care, including community-based treatment
for MDR-TB patients. By providing MDR-TB patients
with access to treatment where they live, USAID
is improving treatment adherence and saving lives.
During the last four years, USAID has worked with
the National TB Program to improve the quality of
care received byTB and MDR-TB patients in several
oblasts (regions) of Ukraine.With USAID support,
treatment success rate among new, bacteriologically-
confirmed patients in the Kherson region has
increased from 50 percent in 20I I to 8I percent
in 2015.Anastasia, an MDR-TB patient supported
through USAID's program, testifies:"l am determined
to complete my treatment now that I can receive my
anti-TB medicines just in the village where I live."
In Tanzania, USAID is working to improve patient
outcomes and treatment adherence through regular
supervision and support for ambulatory MDR-TB
programs. USAID sponsors quarterly visits during
which staff from regional and local health facilities
review the quality of ambulatory MDR-TB treatment
services, patient support systems, and data collection
systems.They review patient records to monitor
clinical improvement or deterioration and the
prevalence of side effects, and they visit patients in
their homes to provide adherence counseling and
advice on the management of side effects. During
June - September 20I5, the supervisory team visited
I 24 (98 percent) of MDR-TB patients. Of this total,
26 patients were found to have interrupted their
treatment; 18 of these patients resumed treatment
following the team's visit.6 https://www.nationalacademies.org/hmd/-/media/Files/Report%20
Files/2001I/Crossing-the-Quality-Chasm/Quality%2OChasm%20
2001 %20%20report%20brief.pdfFiscal Year 2015 I Ending the Tuberculosis Epidemic 13
I
12 Ending the Tuberculosis Epidemic I Fiscal Year 2015
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Ending the Tuberculosis Epidemic, text, Date Unknown; (https://digital.library.unt.edu/ark:/67531/metadc955180/m1/7/: accessed April 27, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.