This study assessed the level of optimization of turnaround time (TAT) among the Tuberculosis Directly Observed Treatment Short-Course (TB DOTS) team and explored the treatment-compliance experiences of confirmed pulmonary tuberculosis (PTB) patients in the Rural Health Unit of Sagñay, Camarines Sur. A concurrent parallel mixed-methods design was employed. Quantitative survey data were obtained from 40 confirmed PTB patients, eight of whom were purposively selected for semi-structured interviews, while six TB DOTS team members participated in a focus group discussion. Quantitative data were summarized using weighted and average means, whereas interview and focus-group data were examined through content and thematic analysis and integrated with the quantitative findings. The TB DOTS team demonstrated a very high overall level of TAT optimization (M = 4.29), with screening (M = 4.24), diagnostics (M = 4.27), treatment initiation (M = 4.31), and follow-up (M = 4.36) all rated very high. Important service gaps nevertheless emerged in timely communication of diagnostic results (M = 2.63, Moderate), treatment initiation within five working days of sputum collection (M = 3.85, High), and attendance at scheduled follow-up visits (M = 3.65, High). Patients described symptom recognition, transportation and financial barriers, prolonged waiting for diagnostic results, treatment side effects, and family or healthcare-worker support as central to adherence. Staff identified awareness, knowledge of diagnostic TAT, and appropriate communication as facilitators, while distance and limited schedules, insufficient staffing, and inadequate budget were hindering factors. These findings informed the proposed REACH TB Project, a patient-centered program designed to strengthen decentralized specimen transport, community outreach, adherence support, and sustainable financing. The study concludes that RHU-Sagñay has a strongly functioning TB DOTS system, but targeted improvements in result communication, logistical access, staffing, and follow-up are needed to make timely TB care more consistent and sustainable.
Abstract Tuberculosis (TB) remains a global public health challenge, particularly in resource-limited settings, where centralized diagnostic systems may be constrained by logistical delays, infrastructure gaps, and limited workforce capacity. In recent years, decentralized diagnostic approaches have emerged as promising alternatives to improve access, timeliness, and patient-centered care. This narrative review examines the evolving landscape of decentralized TB diagnostics in primary laboratories, especially in the post-COVID-19 era, where pandemic-related investments in health infrastructure and digital systems have created new opportunities for diagnostic reform. We identify and synthesize five persistent implementation challenges â quality assurance, human resource limitations, infrastructural deficits, financial sustainability, and community engagement â as well as several key enablers, including portable molecular technologies, digital health platforms, and policy-linked diagnostic networks. This review highlights the importance of embedding decentralized models into national TB programs, supported by regulatory frameworks, sustainable financing, and cross-sector collaboration. Accelerating the institutionalization of decentralized diagnostics is essential to achieving diagnostic equity and advancing TB elimination goals in high-burden countries.
INTRODUCTION: This article reports the results and the lessons learned from implementing the decentralized approach to tuberculosis (TB) detection and treatment, embedded with Human Immunodeficiency Virus (HIV) co-infection in health district. The objective was to increase the TB screening indicators in the district using the common ways for offering care to patients in health district. METHODS: Conducted from August 2006 to July 2007, this large-scale intervention using Non-experimental study Designs has implemented a decentralized approach for fighting against TB in Orodara Health District (OHD), Burkina Faso. Pretest-posttest design has been used for quantitative part using indicators in one hand, and postests-only design for the qualitative part in other hand. In the pretest-posttest design, the TB indicators from years before 2006 (from 2002 to 2005) were used as earlier measurement observations allowing examining changes over time. The decentralized approach was incorporated into the annual planning of the OHD. For the quantitative study design, indicators used were those from National TB Program in Burkina Faso: TB detection rate, incidence density of TB per 100,000 inhabitants per year, and HIV prevalence in incident TB cases with positive smears. Data entry and analysis employed Microsoft Access and Excel software. For the qualitative, in-depth interview was used in which a total of 16 persons have been interviewed. Discussions were tape-recorded and transcribed verbatim for analysis using the computer-based qualitative software program named QSR NVIVO. RESULTS: There were a total of 99,259 outpatient visits during the study period: the7,345 patients (7.43%) presented with cough. Of the 7,345 patient having cough, 503 cases (6.8%) were declared chronic coughing. These 503 patients were screened for TB, including 35.59% whose coughing had lasted 10 to 15 days. We observed an increase in a measured variable was observed. The TB detection rate and incidence-density rate based on positive smears were 16.11% (11.00% in 2005) and 10.42 per 100,000 inhabitants per year (6.88 per 100,000 inhabitants in 2005), respectively. There were 29 patients positive for TB: 41.37% of these had cough lasting 10 to 15 days, 10.34% were also positive for HIV, and 68.97% were from rural areas. Health workers and patients reported satisfaction with the intervention. It was found that implementing a decentralized approach to TB prevention in rural areas is plausible and effective under some conditions: considering that health district system is functional; carefully designing the intervention for TB case management; setting up and implementing of decentralized approach including strong monitoring; and taking into account the all financing, community and volunteer involvement, evaluation of the cost savings from integrating specific donor funding, and being supported by regional and central levels including National TB program. CONCLUSION: The study has shown that TB detection rate can be increased by implementing a decentralized approach to primary care. When carefully implemented, a decentralized approach is a suitable approach to TB and HIV prevention in rural and inaccessible settings.