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Open Access The referral pathway of presumptive drug-resistant tuberculosis in an urban poor setting, The Philippines

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Setting: Socio-economically underprivileged urban areas in the Philippines.

Objectives: To identify gaps in the referral pathway of presumptive drug-resistant tuberculosis (DR-TB) patients from initial consultation until initiation of treatment.

Design: A retrospective study in which a masterlist of presumptive multidrug-resistant TB (MDR-TB) patients registered in 18 DOTS facilities in Tondo, Manila and Payatas, Quezon City, from October 2012 to September 2013, was analysed and reviewed.

Results: Among 378 presumptive DR-TB patients identified and listed in the masterlist, 97% (368/378) were referred, of whom 90% (333/368) were screened at an MDR-TB treatment centre. Of the 368 patients, 35 (9.5%) were not screened, mainly due to loss to follow-up. Among those screened, 86.4% (288/333) were recommended for anti-tuberculosis treatment, of whom 98.2% (283/288) initiated treatment. The time between sample collection and examination was significantly longer at the laboratories of non-government organisations (NGOs) than at local government units (LGUs) (1 day vs. 0 day; P < 0.001). The time to the release of smear examination results to patients was significantly shorter at the NGOs than at the LGUs (4 days vs. 6 days; P = 0.009).

Conclusion: The development of the presumptive MDR-TB masterlist facilitated tracking of patients for diagnosis and treatment. The NGOs should reduce delays in diagnosis and the LGUs should intensify patient follow-up to ensure early initiation of treatment.
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Keywords: bacterial infection; consultation; delayed diagnosis

Document Type: Research Article

Affiliations: 1: Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association (RIT/JATA) Philippines, Manila, The Philippines 2: RIT/JATA, Tokyo, Japan, Department of Paediatrics, National Hospital Organisation Minami-Kyoto Hospital, Kyoto, Japan 3: Manila Health, Department, Manila, The Philippines 4: Quezon City Health Department, Quezon City, The Philippines 5: National Capital Region Office, Mandaluyong, The Philippines 6: Disease Prevention and Control Bureau, Department of Health, Manila, The Philippines 7: Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association (RIT/JATA) Philippines, Manila, The Philippines, RIT/JATA, Tokyo, Japan

Publication date: December 21, 2016

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  • Public Health Action (PHA), The Union's quarterly open access on-line journal, provides a platform for its mission 'Health solutions for the poor'. PHA addresses the need for show-casing operational research that addresses issues in health systems and services. It publishes high-quality scientific research that provides new knowledge to improve access, equity, quality and efficiency of health systems and services.

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