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Lancet Infect Dis. 2019 Aug 22. pii: S1473-3099(19)30420-7. doi: 10.1016/S1473-3099(19)30420-7. [Epub ahead of print]

Improving the cascade of global tuberculosis care: moving from the "what" to the "how" of quality improvement.

Author information

1
HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, CA, USA; Division of Global Epidemiology, University of California, San Francisco, CA, USA; Institute for Implementation Science in Population Health, City University of New York, NY, USA. Electronic address: bruce.agins@ucsf.edu.
2
HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, CA, USA; Harvard Medical School, Boston, MA, USA.
3
Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA.
4
McGill International TB Centre, McGill University, Montreal, Canada.
5
Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA.

Abstract

Tuberculosis is preventable, treatable, and curable, yet it has the highest mortality rate of infectious diseases worldwide. Over the past decade, services to prevent, screen, diagnose, and treat tuberculosis have been developed and scaled up globally, but progress to end the disease as a public health threat has been slow, particularly in low-income and middle-income countries. In these settings, low-quality tuberculosis prevention, diagnostic, and treatment services frustrate efforts to translate use of existing tools, approaches, and treatment regimens into improved individual and public health outcomes. Increasingly sophisticated methods have been used to identify gaps in quality of tuberculosis care, but inadequate work has been done to apply these findings to activities that generate population-level improvements. In this Personal View, we contend that shifting the focus from the "what" to the "how" of quality improvement will require National Tuberculosis Programmes to change the way they organise, use data, implement, and respond to the needs and preferences of people with tuberculosis and at-risk communities.

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