Project extension for community healthcare outcomes improves care and treatment for multidrug-resistant tuberculosis patients in Tanzania.
Daud Dunstan Peter, Shabani Ramadhani Mziray, Isack Augustino Lekule, Victor Kitundu, Salum Mohamed, Riziki Michael Kisonga, Stellah George Mpagama, Bruce Baird Struminger
Author Information
Daud Dunstan Peter: Department of Clinical Services, Kibong'oto Infectious Diseases Hospital; Rural and Urban Community Health Based Organization, Kilimanjaro, Tanzania.
Shabani Ramadhani Mziray: Department of Medical Laboratory Services, Kibong'oto Infectious Diseases Hospital; Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi; Rural and Urban Community Health Based Organization, Kilimanjaro, Tanzania.
Isack Augustino Lekule: Department of Preventive Services, National Tuberculosis and Leprosy Program, Dodoma, Tanzania.
Victor Kitundu: Department of Internal Medicine, Dodoma Regional Referral Hospital, Dodoma, Tanzania.
Salum Mohamed: Department of Infectious Diseases, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Riziki Michael Kisonga: Department of Clinical Services, Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania.
Stellah George Mpagama: Department of Clinical Services, Kibong'oto Infectious Diseases Hospital, Kilimanjaro, Tanzania.
Bruce Baird Struminger: Division of Infectious Diseases, The ECHO Institute, University of New Mexico Health Sciences Centre, New Mexico, United States.
Background: Project Extension for Community Healthcare Outcomes (Project ECHO) is a telementoring, case based virtual community of practice training and education model connecting experts to primary care clinicians (PCCs). Project ECHO has good evidence for favorable treatment outcomes on wide range of diseases. Since 2017, Tanzania hosts multidrug resistant tuberculosis (MDR TB) ECHO with hub at Kibong'oto Infectious Diseases Hospital. However, little is known on outcomes of MDR TB ECHO. This study aimed to describe the outcomes of MDR TB ECHO in managing MDR TB patients in Tanzania. Methods: Review of case studies was conducted at MDR TB ECHO hub in Tanzania. Up to June 2020, a total of 134 sessions and 60 patient cases were presented in MDR TB ECHO. This article describes outcomes of MDR TB ECHO in managing three selected complicated MDR TB patient cases presented. Case 1: Child with MDR TB, neck abscess, and anemia secondary to chronic illness. Case 2: Adult with MDR TB and end stage renal disease co morbidity. Case 3: Adult failing standard MDR TB treatment. Results: Anemia resolved in Case 1; surgical dressing was done to neck abscess and neck healed. Case 2 was initiated with end stage renal disease management; uremic encephalopathy and lower limb edema resolved. Case 3 was initiated with individualized MDR TB treatment. All three patients attained smear and culture conversion and continue with MDR TB treatment. Conclusions: To our knowledge, this is the first report on effectiveness of project ECHO in supporting PCCs in bringing favorable treatment outcomes to MDR TB patients. We advocate adaptation and scale up of ECHO model as an effective approach for strengthening management of MDR TB and other infectious diseases.
