Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #100767

I.D. Rusen, MD MSc, Chen-Yuan Chiang, MD MPH, Donald A. Enarson, MD, and Sven Gudmund Hinderaker, MD PhD. Department of Scientific Activities, International Union Against Tuberculosis and Lung Disease (The Union), 68, boulevard Saint-Michel, 75006, Paris, France, (33) 1 44 32 03 60, IRusen@iuatld.org

Patient interviews as a tool to improve tuberculosis program service delivery: Experiences from the FIDELIS initiative

Purpose: To describe the role of patient interviews as one component of monitoring the quality of tuberculosis control services.

Information used: The experiences and information were collected as part of the FIDELIS initiative (Fund for Innovative DOTS Expansion through Local Initiatives to Stop Tuberculosis) – an $11 million USD Canadian International Development Agency (CIDA)-funded and International Union Against Tuberculosis and Lung Disease (The Union)-managed initiative to increase global case detection of infectious tuberculosis cases.

Methods: A total of 32 FIDELIS projects have been implemented in 13 low-income countries. FIDELIS technical monitors visit each project at least twice in the one-year project duration. The systematic monitoring visits include patient interviews, usually randomly selected and conducted at the home of recently diagnosed tuberculosis cases. Issues addressed during the patient interviews include symptom onset, care-seeking behavior, stigma associated with the disease and personal financial costs involved in seeking care.

Major results: Patient interviews often reaffirm the technical problems observed during the health center reviews. Moreover, they underscore key aspects of tuberculosis care that must be addressed to improve the quality of service delivery (e.g. patients experience long delays to diagnosis and treatment initiation and treatment for many patients is not directly observed). Finally, several cases to be presented highlight the significant personal financial costs experienced by patients in seeking care for a disease for which ‘free treatment' is promoted.

Recommendations: Patient interviews contribute to the evidence base required to improve health services delivery. These interviews should be adopted as a standard of practice for routine monitoring and supervision of tuberculosis control services in low-income countries.

Learning Objectives: At the conclusion of this session, the participant (learner) attending will be able to

• Describe the FIDELIS initiative and its role in increasing global case detection of infectious tuberculosis cases
• Recognize the role of patient interviews in assessing the quality of tuberculosis control services in FIDELIS projects and in National Tuberculosis Programs in general
• List five key findings that have emerged from a series of systematic patient interviews

Keywords: Tuberculosis, Patient Perspective

Related Web page: www.fidelistb.org

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.