title: Ambulatory care for multidrug-resistant tuberculosis: lessons learned in Addis Ababa, Ethiopia.
abstract: METHODS
  Ethiopia is one of the high multidrug-resistant tuberculosis (MDR-TB) burden countries. Efforts by the National TB Programme to control MDR-TB include expanding ambulatory care.
  
  
  OBJECTIVE
  To investigate the opportunities and challenges faced by treatment follow-up health centres (TFCs) when managing MDR-TB patients, with greater focus on recording, TB infection control (IC) and supervision practices.
  
  
  METHODS
  A facility-based cross-sectional study was conducted by reviewing the records of all MDR-TB cases in all 25 TFCs in Addis Ababa, Ethiopia. The TB focal point, pharmacy and laboratory heads were also interviewed.
  
  
  RESULTS
  A total of 221 MDR-TB patients were registered; 157 (71%) patients had been referred from one of the two treatment initiating centres. While some TFCs oversaw up to 41 patients, others had just one patient. The majority of the TFCs (n = 21, 84%) followed standardised TB IC procedures. Poor documentation of patient information was observed at all sites; for example, human immunodeficiency virus and current treatment status was not indicated for respectively 86 (38%) and 41 (18%) patients.
  
  
  CONCLUSIONS
  The study revealed that infection prevention practices were largely adhered to. Documentation of patient-related information was a major challenge, and regular supervision of the TFCs should be emphasised. Record keeping is critical.
authors.affiliation: Tuberculosis Research Advisory Committee of the Federal Ministry of Health, Addis Ababa, Ethiopia ; TB CARE I/KNCV Tuberculosis Foundation, Country Office, Addis Ababa, Ethiopia.
authors.forename: D
authors.initials: D
authors.lastname: Fiseha
authors.affiliation: Addis Ababa City Administration Regional Health Bureau, Addis Ababa, Ethiopia.
authors.forename: H
authors.initials: H
authors.lastname: Kumssa
authors.affiliation: Entoto Fana Health Centre, Addis Ababa, Ethiopia.
authors.forename: M
authors.initials: M
authors.lastname: Tefera
authors.affiliation: Addis Ababa City Administration Regional Health Bureau Regional Laboratory, Addis Ababa, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Tesfaye
authors.affiliation: KNCV Tuberculosis Foundation, the Hague, the Netherlands ; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Klinkenberg
authors.affiliation: College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: G
authors.initials: G
authors.lastname: Yimer
keywords: infection control; operational challenges; recording and reporting; referral linkage; treatment follow-up centres