title: Quality of tuberculosis care in high burden countries: the urgent need to address gaps in the care cascade.
abstract: Despite the high coverage of directly observed treatment short-course (DOTS), tuberculosis (TB) continues to affect 10.4 million people each year, and kills 1.8 million. High TB mortality, the large number of missing TB cases, the emergence of severe forms of drug resistance, and the slow decline in TB incidence indicate that merely expanding the coverage of TB services is insufficient to end the epidemic. In the era of the End TB Strategy, we need to think beyond coverage and start focusing on the quality of TB care that is routinely offered to patients in high burden countries, in both public and private sectors. In this review, current evidence on the quality of TB care in high burden countries, major gaps in the quality of care, and some novel efforts to measure and improve the quality of care are described. Based on systematic reviews on the quality of TB care or surrogates of quality (e.g., TB diagnostic delays), analyses of TB care cascades, and newer studies that directly measure quality of care, it is shown that the quality of care in both the public and private sector falls short of international standards and urgently needs improvement. National TB programs will therefore need to systematically measure and improve quality of TB care and invest in quality improvement programs.
authors: McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada.
authors: Danielle
authors: D
authors: Cazabon
authors: McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada.
authors: Hannah
authors: H
authors: Alsdurf
authors: McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada.
authors: Srinath
authors: S
authors: Satyanarayana
authors: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors: Ruvandhi
authors: R
authors: Nathavitharana
authors: Division of Infectious Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors: Ramnath
authors: R
authors: Subbaraman
authors: McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada; CAPRISA MRC HIV-TB Pathogenesis and Treatment Research Unit, University of KwaZulu-Natal, South Africa.
authors: Amrita
authors: A
authors: Daftary
authors: McGill International TB Centre, McGill University, 1020 Pine Ave West, Montreal, QC H3A 1A2, Canada; Manipal McGill Centre for Infectious Diseases, Manipal University, Manipal, India. Electronic address: madhukar.pai@mcgill.ca.
authors: Madhukar
authors: M
authors: Pai
mesh_terms: D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D018802:Patient-Centered Care / Q000592:standards*; D017149:Private Sector; D016730:Program Development; D017150:Public Sector; D058996:Quality Improvement; D011787:Quality of Health Care; D014376:Tuberculosis / Q000453:epidemiology / Q000628:therapy*; D018088:Tuberculosis, Multidrug-Resistant / Q000628:therapy
keywords: Cascade of care; Quality improvement; Quality of care; Standards for TB care; Tuberculosis