An Evaluation of the Tuberculosis Prevention and Care Program in Gweru District, 2022: The Need to Increase Bacteriological Coverage

Abstract

Introduction: Tuberculosis remains a disease of public health concern. The national TB program has onsite laboratories (with Gene Xpert and CXR services) and is supported by a partner with mobile screening trucks that are equipped with the same equipment. Despite the availability of the xMTB-Rif, program data shows that the district has low bacteriological coverage (36.5%) in 2021-2022 instead of the expected 90%. Therefore, the study evaluated the TB control program in Gweru District to assess the inputs, processes, and outcomes of the program and determined the possible reasons for low bacteriological coverage.

Methods: A descriptive cross-sectional study design using the CDC logic model for program evaluation was conducted in Gweru district. A sample of 110 patient records was selected. Structured key informant interviews and checklists were used to collect data from the key informants and TB facility records. Data were analyzed using Epi Info 7.2.4 statistical package to generate, frequencies, means, and proportions. Health worker knowledge of the TB program was assessed and categorised as acceptable and poor using the modified Bloom cut-off point. A thematic analysis of qualitative data was performed.

Results: Patient-related reasons for low bacteriological coverage included failure to produce sputum and health system related included intermittent Xpert cartridge stockouts. Approximately fifteen (14.6) percent of presumptive TB patients missed the opportunity to submit sputa for bacteriological assessment and not all who submitted specimens received results. Bacteriological coverage was 68.1% which is below target. A high (10.0%) death rate was recorded, and 8/11 deaths were clinically diagnosed.

Conclusion: We concluded that low bacteriologic coverage poses multiple challenges including possible misdiagnosis which leads to unfavorable treatment outcomes and preventable costs to TB programs. Higher death rates were observed in clinically diagnosed compared to bacteriologically confirmed individuals. We recommended patient-level data analysis, ensuring that all presumed patients submit sputum, ensuring death audits are conducted.