Assessing components of the TB care cascade in Ghana

TB remains a major public health problem with a significant gap between estimated incident and reported TB cases. In the Ghana TB case cascade, an estimated two-thirds of incident TB cases are not being identified. There is also little is known about treatment outcomes of persons with extrapulmonary TB (EPTB) and childhood TB. The objective of the PhD project was to assess outcomes of case finding interventions implemented and treatment outcomes focusing among those with EPTB and childhood TB to generate evidence-based data.
The methodology involved retrospective analyses of National TB Program (NTP) data from TB case finding activities in health facilities, contact tracing and mining communities.
The results highlighted that systematic screening of high-risk OPD patients particularly PLHIV and diabetics, using a short duration symptom screening and screening of other targeted risk groups in the community (miners and contacts of index TB patients) can significantly enhance TB case finding. Implementing these strategies are feasible making use of existing programmatic structures, increasing access to sensitive screening algorithms and diagnostic tests and building relevant capacity.
For those with extrapulmonary and childhood TB, mortality accounted for poor treatment outcome and HIV positivity was the major risk factor. Enhancing TB/HIV collaborative services to minimize barriers to integrated care delivery could improve survival and have a positive impact on treatment outcome.
The findings from these studies provide the NTP with evidence of strategies which can be implemented to narrow the gap between estimated incident and reported TB cases and improve treatment outcomes.