Contributing Factors in the Tuberculosis Care Cascade in India: A Systematic Literature Review

Sandul Yasobant; Priya Bhavsar; Pachillu Kalpana; Farjana Memon; Poonam Trivedi; Deepak Saxena

doi:10.2147/RMHP.S322143

Contributing Factors in the Tuberculosis Care Cascade in India: A Systematic Literature Review

Risk Manag Healthc Policy. 2021 Aug 10:14:3275-3286. doi: 10.2147/RMHP.S322143. eCollection 2021.

Authors

Sandul Yasobant^{1

2}, Priya Bhavsar¹, Pachillu Kalpana¹, Farjana Memon¹, Poonam Trivedi¹, Deepak Saxena^{1

2

3}

Affiliations

¹ Department of Epidemiology, Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, 382042, India.
² Center for One Health Education, Research, and Development (COHERD), Indian Institute of Public Health Gandhinagar (IIPHG), Gandhinagar, 382042, India.
³ Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (DMIMS), Wardha, 442004, India.

Abstract

Tuberculosis (TB) care cascade is a recently evolved care model for patient retention across the sequential stages of care for a successful treatment outcome. The care cascade is multi-folded and complex in setting where the health system is reforming for its resilience. India, one of the countries with the highest burden of tuberculosis mortality and morbidity, is not an exception to this complexity. With the diverse challenges in the Indian health system and societal diversity, it is essential to understand the factors contributing to this TB care cascade. Thus, this study aims to map all the contributing factors to the TB care cascade in India. Further, it also captures the different patterns of factors explored so far in different countries' regions. This systematic literature review was conducted between October 2020 and February 2021 in India using PubMed databases, Web of Science, and Google Scholar. Two reviewers extracted the data from eligible studies to summarize and tabulate important findings. Data were extracted and tabulated for study design, location of the study, type of TB patients, methodological approach, system side challenges, and demand-side challenges in the study's findings. Out of 692 initial hits from the literature search, 28 studies were finally included to synthesize evidence in this review as per the inclusion and exclusion criteria. This review provides an insight into different factors such as the system-side (health workforce, institutional) and the demand-side (individual, societal) contributing towards the care cascade. The prime factors reflected in most of the studies were socio-economic condition, disease awareness, myths/beliefs, addictions among the demand-side factors and accessibility, the attitude of the healthcare staff, delay in referral for diagnosis among the system-side factors. The accountability for addressing these diverse factors is recommended to close the gaps in the TB care cascade.

Keywords: India; care cascade; care-seeking; factors; tuberculosis.

Publication types

Review

Grants and funding

This study is made possible by the generous support of the American People through the United States Agency for International Development (USAID). The work described in this article was implemented under the USAID Closing the gaps in TB Care Cascade Project, managed by World Health Partners under the terms of Cooperative Agreement Number 72038620CA00012. Staff of the funding agency critically reviewed the draft and offered comments to improve the paper.