Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia

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dc.contributor.authorZulu, Joseph Mumba
dc.contributor.authorMaritim, Patricia
dc.contributor.authorHalwiindi, Hikabasa
dc.contributor.authorChavula, Malizgani Paul
dc.contributor.authorMunakampe, Margarate
dc.contributor.authorMatenga, Tulani Francis L
dc.contributor.authorMweemba, Chris
dc.contributor.authorSinyangwe, Ntazana N
dc.contributor.authorHabib, Batuli
dc.contributor.authorMusukuma, Mwiche
dc.contributor.authorSilumbwe, Adam
dc.contributor.authorWang, Bo
dc.contributor.authorKaonga, Patrick
dc.contributor.authorChewe, Mwimba
dc.contributor.authorFisa, Ronald
dc.contributor.authorBanda, Jeremiah
dc.contributor.authorMubanga, Angel
dc.contributor.authorPhiri, Henry
dc.contributor.departmentBiostatistics and Health Services Researchen_US
dc.contributor.departmentPopulation and Quantitative Health Sciencesen_US
dc.date.accessioned2024-10-16T17:35:48Z
dc.date.available2024-10-16T17:35:48Z
dc.date.issued2024-09-14
dc.description.abstractBackground: Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia. Methods: Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action. Results: The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members. Conclusion: This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).en_US
dc.identifier.citationZulu JM, Maritim P, Halwiindi H, Chavula MP, Munakampe M, Matenga TFL, Mweemba C, Sinyangwe NN, Habib B, Musukuma M, Silumbwe A, Wang B, Kaonga P, Chewe M, Fisa R, Banda J, Mubanga A, Phiri H. Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia. Arch Public Health. 2024 Sep 14;82(1):157. doi: 10.1186/s13690-024-01384-4. PMID: 39277746; PMCID: PMC11401366.en_US
dc.identifier.doi10.1186/s13690-024-01384-4en_US
dc.identifier.issn0778-7367
dc.identifier.journalArchives of public health = Archives belges de sante publique
dc.identifier.pmid39277746
dc.identifier.urihttps://hdl.handle.net/20.500.14038/53865
dc.language.isoen
dc.relation.ispartofArchives of Public Healthen_US
dc.relation.urlhttps://doi.org/10.1186/s13690-024-01384-4en_US
dc.rights© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.en_US
dc.rightsAttribution 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.source.beginpage157
dc.source.countryEngland
dc.source.endpage
dc.source.issue1
dc.source.journaltitleArchives of public health = Archives belges de sante publique
dc.source.volume82
dc.subjectCommunity health systemsen_US
dc.subjectDecentralized programmatic management of multidrug-resistant tuberculosisen_US
dc.subjectImplementation strategiesen_US
dc.subjectZambiaen_US
dc.titleImplementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambiaen_US
dc.typeJournal Articleen_US
dspace.entity.typePublication
refterms.dateFOA2024-10-16T17:35:50Z
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