aed's pathway cough to cure - s. waisbord

7/25/2019 AED's Pathway Cough to Cure - S. Waisbord

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Cough to Cure: Applying aPathway of Ideal Behaviors in TB Control

AED: Dr. Silvio Waisbord

Dr. Susan Zimicki

Stop TB Partnership: Thaddeus Pennas


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Overview of Presentation

Introduction: The Cough to Cure Pathway

- a diagnostic and planning tool

The "Cough to Cure Pathway - six steps to

ideal TB treatment

Applying the Pathway: diagnostic steps


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is a diagnostic and planning tool! #hy another tool$

#hat is new a%out the tool$

&ow was it de'eloped$

The "Cough to Cure Pathway



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Why another tool?

(esponse to expressed need!

Countries and technical programs re)uest supportand guidance regarding ad'ocacy* communication

and social mo%ili+ation ,AC.:

This diagnostic and planning tool supports cost-e//ecti'e implementation o/ AC support and

ser'ices!


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What is new about this tool?

0rame o/ re/erence way o/ conceptuali+ing

pro%lems Thin1 a%out communication %y thin1ing a%out

%eha'iors

Beha'iors instead o/ logistics and structure

0ocus People ,patients and pro'iders.

2iew o/ system

3na%ling en'ironment


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How was it developed?

A34 wor1ing with top TB:

4e/ined the steps in the pathway /rom cough tocure /rom the patient5s care-see1ing practices

Identi/ied the social and %eha'ioural %arriers to

completing each o/ these steps ,through literature

re'iew and inter'iews.

6apped possi%le AC entry points drawing on

lessons /rom other %eha'ioural change

inter'entions


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is a diagnostic and planning tool! The "Cough to Cure Pathway

&ow does it wor1$

Basic structure six steps

Barriers ,indi'idual* group* system.

3xamples



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How does it wor?

This pathway was de'eloped to ser'e as a roadmap to understand the interrelationship o/%eha'iour* 47T ser'ices and other societalstructures on treatment-see1ing %eha'iour andcompliance!

The pathway /ocuses on the patient* andhow thesystem can /acilitate patients5 going through theideal steps!


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The Pathway ! basi" stru"ture

ix steps to ideal TBtreatment %eha'ior :

8. ee1 timely care

9. o to a 47T /acility

;. et accurate diagnosis

. Begin treatment

?@ Current a'erage:@

Treatment completion oal:


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Ideal vs reality

In an ideal world* /or e'ery 8?? in/ected people* all 8?? would:

ee1 timely care

o to a 47T /acility either directly through re/erral Be correctly diagnosed

Begin treatment

Persist with treatment /or more than 9 months

Complete treatment These are the six steps that /orm the %asic structure o/ the

pathway

As the /ollowing slide shows* things are /ar /rom ideal


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Pathway #teps


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The Pathway ! $ist of barriers

At each step* the pathway also lists thecommon %arriers to completion o/ the step

Barriers can occur at the le'el o/ the Indi'idual

roup

ystem

The current list o/ %arriers is %ased on A345sliterature re'iew and inter'iews it will %eupdated as program experience accrues


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Barriers % individual and grouplevel

#tep & ! 'o to (OT#

Common reasons /or non-completion are that the

indi'idual Pre/ers to go to a pro'ider she 1nows* and /ears going to

someone un1nown

Belie'es attending 47T /acility will %e expensi'e

4oesn5t prioriti+e TB o'er other health issues

Dow-ris1 perception o/ TB symptomsAnd that the group ,community/amily.

tigmati+es people with tu%erculosis and* %y extension* anyone

attending a TB clinic


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Barriers ! syste)level

#tep & ! 'o to (OT#

0ew 47T /acilities* so that people li'e

relati'ely /ar away and tra'eling to the /acility

ta1es time and money

Dac1 o/ lin1ages %etween non-47T and 47T

/acilities

E pro'iders do not re/er patients with possi%le TB to47T /acilities

E pro'iders do not consider TB ,e!g!* treat &I2 patients

only /or &I2 F acute illnesses.


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Barriers % individual and grouplevel

#tep * +Persist with treat)ent,

Common reasons /or drop-out are that the

indi'idualand hisher social support group,/amily* neigh%ors. 4o not 1now how long treatment ta1es

4o not understand or accept the importance o/

continuing treatment e'en a/ter the patient /eels%etter or despite side e//ects

Cannot /inancially support the cost o/ distant

treatment or good /ood

tigmati+e those with TB


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Barriers ! syste)level

#tep * +Persist with treat)ent,

Dac1 o/ medicines

Dac1 o/ 47T /acilities - trou%le ,time* money.to attend

Pro'iders /ail to gi'e ade)uate in/ormation

a%out length o/ treatment* importance o/

persistence* side e//ects Poor )uality o/ ser'ices ,e!g!* non-supporti'e

or a%usi'e pro'iders.


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is a diagnostic and planning tool! The "Cough to Cure Pathway"Gsix steps to

ideal TB treatment

Applying the Pathway: diagnostic steps 4escription

3xamples


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Applying the Pathway: - #teps

8! Identi/y the steps that patients are notcompleting

9! 3xamine the reasons /or non-completion atthe indi'idual* group and systems le'els

;! 4ecide which %arriers to address! Heed to

weigh relati'e importance o/ /actors! Choose an inter'ention %ased on

understand o/ moti'ating /actors* and li1elye//ecti'eness and impact


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How to e.a)ine step "o)pletion

7%tain in/ormation a%out step completion /rom a 'arietyo/ sources

(outine in/ormation pecial studies

ey in/ormants

Chart out the data and let it guide the decision ma1ing

process

Important: %e clear a%out denominators 6a1e sure all your percents re/er to the same %ase population


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#tep &/ 0.a)ine reasons for )issed

steps

In this case* the program should examine

indi'idual* group and systems %arriers thatare li1ely to %e pro%lems /or %oth step 8 and

/or step 9!


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0.a)ple: for #tep & +'o to (OT#,

Possi%le reasons include

Indi'idual:6isperceptions o/ costs o/ diagnosis and treatment

(eluctance to go to an un1nown pro'ider

rouptigma

ystem4istance to 47T pro'ider

Ho or wea1 lin1s %etween non-47T and 47T pro'iders

non-re/erral


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How to e.a)ine reasons

Jse %oth )ualitati'e and )uantitati'e research 3xamples o/ some )uestions rele'ant to indi'idual

and group-le'el %arriers /or tep 9: #here should someone go to /ind out i/ she or he has TB$

&ow much does it cost to %e tested$

Can TB %e cured$

&ow much does it cost$ &ow long does it ta1e$

&ow would your /amily and neigh%ors react i/ they 1newthat you went to a 47T clinic$


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#tep 1/ (e"ide whi"h barrier+s, to address

#hat is the relati'e importance o/ this %arriercompared to others$

&ow /easi%le is to reduce this %arrier within ashort-to-medium period$

&ow much will it cost ,cost%ene/it analysis.$

4oes the program ha'e the right expertise totac1le the pro%lem ,human resourceanalysis. $


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#tep -/ Choose an intervention

#hat 1inds o/ inter'entions will %est addressthe identi/ied %arrier,s.$ ystems impro'ement ,e!g!* logistics. Beha'ioural change o/ patients andor

pro'iders 6ixed ,what is the se)uence$.

#hat 1ind o/ communication strategy is %estade)uate to address %arriers$


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Core 2uestions for "o))uni"ation

interventions

#ho is the primary and secondary audience$ #hat is it that they are expected to do$ #hat will it ta1e to get people to do it$

#hat do they need to 1now$

#hat do they 'alue$

&ow will they o'ercome percei'ed and existing

%arriers$ #hat /actors promote their doing it$

these come /rom the B3&A23 model many other models exist: HCI Pin1Boo1* P-Process* Com%i* C4Cynergy* K.


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Than you

Academy /or 3ducational

4e'elopment and the

top TB Partnership

ecretariat

aed's pathway cough to cure - s. waisbord

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