Using Patient Pathway analysis in Rwanda: Methods, problems and the importance of data and sensitivity analysis
E-poster presented during the Union World Conference 2020.
Puck Pelzer, Sarah van de Berg, Augustin Dushime, Patrick Migambi, Max Meis, KNCV Tuberculosis Foundation.
Background
- TB ranks third in causes of death in Rwanda
- Late diagnosis and treatment may contribute to mortality
- There is limited information on access to care for persons with TB symptoms in Rwanda
- We aimed to assess alignment of health care seeking behavior and TB service availability
Design/method
- A national level PPA was completed using 2014/15 DHS data and Master Facility List from the National Ministry of Health
- The primary measures were place of initial care seeking, TB diagnostic- and treatment locations
- We conducted sensitivity analyses using different definitions for the primary measures
Results
- Most persons with TB symptoms sought care at the public level 1 facilities
- All public level 1 facilities had diagnostic capacity – or sample transportation and can provide first-line treatment
- Second-line treatment was available at two district hospitals
- 81% of persons with TB symptoms had access to TB diagnostic or treatment services at their “first” visit
- Sensitivity analysis showed that access to care is lower (52%) if care seeking data of children is used as proxy for TB care seeking
Conclusions
- Care seeking and service availability are well aligned in Rwanda
- Divergent results can be obtained from the use of different parameters and definitions
- Sensitivity analyses should be conducted as part of PPA to determine optimal definitions of the PPA measures