International Journal of Mycobacteriology (Jan 2015)
Implementation of a new model for TB-care in a low endemic setting: A challenge in vain?
Abstract
Aim and objectives: To evaluate the implementation of an outpatient TB-clinic in a low-endemic setting. Background: In May 2014 the World Health Organization (WHO) approved the post-2015 global tuberculosis (TB) strategy including the plan for elimination of TB in low-endemic countries. Sweden is a low-endemic country, but accepts large numbers of immigrants (e.g. 116,000 in 2013) and a majority from countries where TB is common. In order to prevent TB and ensure accessibility a new outpatient clinic for adults was initiated at a specialist hospital in a suburb of Gothenburg, Sweden, in February 2014. The population living in this suburd is overrepresented among the active cases of TB and in some subgroups the incidence is equal or even higher than in high-endemic countries. The objective is early detection and treatment of active disease and latent TB infection (LTBI) in a social medical perspective. Methods: A descriptive approach made from the experiences of the authors. Results: The TB-care in Gothenburg has, before 2014, been centralized to the university hospital. A political decision was taken in 2012, in line with the global TB strategy, to start an outpatient clinic where TB is overrepresented in the population. The decision was to be implemented through collaboration with all healthcare providers. The new clinic was aiming to promote redistribution of patients between the hospitals with an emphasis on accessibility for the patient. The decision was made without the involvement of management and clinical staff. As a result the clinic has solely been able to focus its care on finding LTBI and spreading knowledge and awareness of TB in high-risk groups. Conclusion: A new approach of specialist healthcare is decentralization with emphasis on accessibility, improved preventive possibility and knowledge about the setting. This approach is well suited for TB elimination in order to target high-risk groups. The transition does not occur automatically, and commitment and knowledge is needed on every level in the healthcare system. A political basis is necessary, but for success and change the decision has to be established and anchored among management and healthcare staff. To treat TB-patients at an outpatient specialist clinic is economically beneficial and above all causes a positive effect on the patient's psychosocial well-being and adherence to treatment. Unfortunately, the present infrastructure of TB-care in Sweden, as well as the will and knowledge of the staff to adapt and change according to the political decision, is preventing optimal care for TB-patients based on the global TB strategy for elimination. Acknowledgement: None to declare.
