Journal Article

Constructing care cascades for active tuberculosis: A strategy for program monitoring and identifying gaps in quality of care

Pai, Madhukar, Mayer, Kenneth H., Subbaraman, Ramnath, Arinaminpathy, Nimalan, Chadha, Vineet K., Nathavitharana, Ruvandhi R., Satyanarayana, Srinath

2019

Overview

The cascade of care is a model for evaluating patient retention across sequential stages of care required to achieve a successful treatment outcome. This approach was first used to evaluate HIV care and has since been applied to other diseases. The tuberculosis (TB) community has only recently started using care cascade analyses to quantify gaps in quality of care. In this article, we describe methods for estimating gaps (patient losses) and steps (patients retained) in the care cascade for active TB disease. We highlight approaches for overcoming challenges in constructing the TB care cascade, which include difficulties in estimating the population-level burden of disease and the diagnostic gap due to the limited sensitivity of TB diagnostic tests. We also describe potential uses of this model for evaluating the impact of interventions to improve case finding, diagnosis, linkage to care, retention in care, and post-treatment monitoring of TB patients.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / AIDS / Analysis / Biology and Life Sciences / Care and treatment / Clinical outcomes / Guidelines and Guidance / HIV / Human immunodeficiency virus / Humans / Infections / Infectious diseases / Medical care quality / Medical research / Medical tests / Medicine and Health Sciences / Mortality / Patient care / Patient monitoring equipment / Patient outcomes / Patients / Program Evaluation - standards / Public health / Quality of care / Quality of Health Care - standards / Strategic planning / Systematic review / Tuberculosis / Tuberculosis - diagnosis / Tuberculosis - epidemiology / Tuberculosis - therapy