title: The referral pathway of presumptive drug-resistant tuberculosis in an urban poor setting, The Philippines.
abstract: Setting:Socio-economically underprivileged urban areas in the Philippines.Objectives:To identify gaps in the referral pathway of presumptive drug-resistant tuberculosis (DR-TB) patients from initial consultation until initiation of treatment.Design:A retrospective study in which a masterlist of presumptive multidrug-resistant TB (MDR-TB) patients registered in 18 DOTS facilities in Tondo, Manila and Payatas, Quezon City, from October 2012 to September 2013, was analysed and reviewed.Results:Among 378 presumptive DR-TB patients identified and listed in the masterlist, 97% (368/378) were referred, of whom 90% (333/368) were screened at an MDR-TB treatment centre. Of the 368 patients, 35 (9.5%) were not screened, mainly due to loss to follow-up. Among those screened, 86.4% (288/333) were recommended for anti-tuberculosis treatment, of whom 98.2% (283/288) initiated treatment. The time between sample collection and examination was significantly longer at the laboratories of non-government organisations (NGOs) than at local government units (LGUs) (1 day vs. 0 day;P< 0.001). The time to the release of smear examination results to patients was significantly shorter at the NGOs than at the LGUs (4 days vs. 6 days;P =0.009).Conclusion:The development of the presumptive MDR-TB masterlist facilitated tracking of patients for diagnosis and treatment. The NGOs should reduce delays in diagnosis and the LGUs should intensify patient follow-up to ensure early initiation of treatment.
authors.affiliation: Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association (RIT/JATA) Philippines, Manila, The Philippines.
authors.forename: E
authors.initials: E
authors.lastname: Lopez
authors.affiliation: RIT/JATA, Tokyo, Japan ; Department of Paediatrics, National Hospital Organisation Minami-Kyoto Hospital, Kyoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yoshimatsu
authors.affiliation: Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association (RIT/JATA) Philippines, Manila, The Philippines.
authors.forename: A
authors.initials: A
authors.lastname: Querri
authors.affiliation: Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association (RIT/JATA) Philippines, Manila, The Philippines.
authors.forename: L
authors.initials: L
authors.lastname: Coprada
authors.affiliation: Manila Health, Department, Manila, The Philippines.
authors.forename: J
authors.initials: J
authors.lastname: Bermejo
authors.affiliation: Quezon City Health Department, Quezon City, The Philippines.
authors.forename: M R
authors.initials: MR
authors.lastname: Paulino
authors.affiliation: National Capital Region Office, Mandaluyong, The Philippines.
authors.forename: A
authors.initials: A
authors.lastname: Medina
authors.affiliation: Disease Prevention and Control Bureau, Department of Health, Manila, The Philippines.
authors.forename: A M C
authors.initials: AM
authors.lastname: Garfin
authors.affiliation: Research Institute of Tuberculosis/Japan Anti-Tuberculosis Association (RIT/JATA) Philippines, Manila, The Philippines ; RIT/JATA, Tokyo, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Ohkado
keywords: bacterial infection; consultation; delayed diagnosis