title: Implementation challenges of a TB programme in rural northern mozambique: evaluation of 2012-2013 outcomes.
abstract: BACKGROUND
  We aimed to identify challenges and to propose solutions for the implementation of tuberculosis (TB) programmes in rural Sub-Saharan Africa (SSA) by evaluating the outcomes of the TB programme in the Ancuabe district in rural Northern Mozambique.
  
  
  METHODS
  Retrospective descriptive study of the patients included in the TB programme in 2012-2013. Follow-up was continued till June 2014.
  
  
  RESULTS
  Three hundred nineteen patients were registered, 62.1% male, mean age 36.3 (SD 14.4), estimated case detection rate (eCDR) of 24.24%. Two hundred seventy-two were new cases, 21 transferred-in, 11 back after lost to follow-up (LTFU), 10 relapsing TB, 5 previous treatment failures. 94.4% were tested for Human immunodeficiency virus (HIV), 41.9% HIV-positive. 87.5% of the new cases were pulmonary TB (PTB), 43.4% were HIV co-infected. Initial sputum results were available in 207 cases, with 145 smear-positive (SP) cases. Outcomes of new cases: 122 (44.9%) LTFU, 55 (20.2%) cured, 43 (15.8%) treatment completed (98-36%-treatment success), 31 (11.4%) died, 19 (7%) transferred out and 2 (0.7%) failures.
  
  
  CONCLUSIONS
  A low eCDR and high proportion of LTFU demonstrate that few patients were identified and had a low probability of complete treatment, suggesting a fragile health system. This raises the hypothesis that, probably, to improve TB health care in rural SSA, interventions should aim at improving health systems. Special attention should be given to social protection and compensation of the financial burden associated with TB.
authors.forename: Philip Erik
authors.initials: PE
authors.lastname: Wikman-Jorgensen
authors.forename: Alejandra
authors.initials: A
authors.lastname: Morales-Cartagena
authors.forename: Jara
authors.initials: J
authors.lastname: Llenas-García
authors.forename: Tomàs Maria
authors.initials: TM
authors.lastname: Pérez-Porcuna
authors.forename: Michael
authors.initials: M
authors.lastname: Hobbins
authors.forename: Jochen
authors.initials: J
authors.lastname: Ehmer
authors.forename: Manuel Aly
authors.initials: MA
authors.lastname: Mussa
authors.forename: Rosa
authors.initials: R
authors.lastname: Abellana
authors.forename: Carlos
authors.initials: C
authors.lastname: Ascaso
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D009073:Mozambique; D012189:Retrospective Studies; D012424:Rural Population; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*
keywords: Directly observed treatment,; Epidemiology,; Mozambique; Tuberculosis,