Background
Methods
Study setting
Sampling frame and sample size
SP training and case scenario
Case description
|
Patient presentation
|
Expected correct management based on 2016 NTP guidelines
|
Expected correct management based on prior SP TB studies
|
---|---|---|---|
A classic case of suspected tuberculosis with a cough for 2–3 weeks and a low-grade fever, cold sweats, loss of appetite and other typical symptoms of TB. | A suspected case of tuberculosis was conveyed to a doctor at a private health service by saying: “Doctor, I have a cough that doesn’t get better.” The patient has no history of COVID-19, has never been tested for COVID-19, but has received a first dose of a COVID-19 vaccine. | Recommendations: 1. Ordered for Xpert MTB/RIF test or AFB smear 2. Referred to Public DOTS center | Recommendations: 1. Ordered for Chest X-rays and/or sputum test (AFB smear, X-pert MTB/RIF, Culture, DST) 2. Referral to another provider or public TB services. |
SP visits and data collection
COVID-19 context and adaptations
Outcome definition
Comparison with pre-COVID-19 SP study
Data analysis
Results
Characteristics of the SP visits
Provider and facility demographics
Provider characteristics
|
INSTEP study, 2018–2019,
N
= 67a | COVET study, 2021–2022, N = 292a |
Provider consented to mapping survey | 56 (84%) | 289 (99%) |
Provider sex | ||
Female | 37 (55%) | 177 (61%) |
Male | 30 (45%) | 115 (39%) |
Provider ageb | 45 (15) | 39 (12) |
Provider qualification | ||
General Practitioner | 52 (78%) | 269 (92%) |
Specialist | 15 (22%) | 23 (7.9%) |
Internist | 14 (93%) | 18 (78%) |
Pulmonologist | 1 (6.7%) | 5 (22%) |
Provider diagnoses at least one TB patient per monthc | 33 (59%) | 165 (57%) |
Average number of TB patients diagnosed per monthc | ||
0 | 23 (41%) | 124 (43%) |
< 1d | 14 (25%) | 0 (0%) |
1–4 | 16 (29%) | 129 (45%) |
5 or more | 3 (5.4%) | 36 (12%) |
Provider dispenses TB treatment to TB patientsc | 12 (21%) | 74 (26%) |
Provider has received TB management trainingc,e | --- | 175 (61%) |
Facility characteristics
| INSTEP study, 2018–2019, N = 56a | COVET study, 2021–2022, N = 165a |
Facility type | ||
Clinic/hospital | 44 (79%) | 116 (70%) |
Solo practice | 12 (21%) | 49 (30%) |
Health sector & linkage to NTP | ||
Private HCF linked to NTP | 1 (1.8%) | 4 (2.4%) |
Private HCF not linked to NTP | 55 (98%) | 161 (98%) |
Additional services present at facilityc | ||
Pharmacy | 39 (70%) | 131 (81%) |
Laboratory | 12 (21%) | 34 (21%) |
X-ray | 6 (11%) | 10 (6.2%) |
Sputum examinatione | --- | 8 (4.9%) |
In-patient bedse | --- | 11 (6.8%) |
Facility collaborates with Indonesian national health insurance (JKN)c | 13 (23%) | 59 (37%) |
Provider screening behaviors
Characteristic | INSTEP study, 2018–2019 | COVET study, 2021–2022 | Difference between studies | |||||
---|---|---|---|---|---|---|---|---|
N = 67a | 95% CIb | N = 292a | 95% CIb | Differencec | 95% CIc,b | p-valuec | q-valued | |
Basic Visit Information | ||||||||
Time spent with provider (min) | 10.9 (7.6) | 9.0, 13 | 9.7 (6.5) | 9.0, 10 | -1.2 | -3.2, 0.84 | 0.3 | > 0.9 |
Number of patients when SP arrived at facility | 3.1 (3.9) | 2.1, 4.1 | 3.7 (6.2) | 3.0, 4.4 | 0.62 | -0.57, 1.8 | 0.3 | > 0.9 |
Number of patients when SP left facility | 2.3 (2.7) | 1.6, 2.9 | 2.7 (4.4) | 2.2, 3.2 | 0.44 | -0.38, 1.3 | 0.3 | > 0.9 |
Correct Management (outcome) | ||||||||
Visit managed in concordance to NTP 2016 guidelines | 19 (28%) | 18%, 41% | 101 (35%) | 29%, 40% | 6.2% | -6.8%, 19% | 0.4 | > 0.9 |
Visit managed in concordance to NTP 2021 guidelines | 0 (0%) | 0.00%, 6.8% | 3 (1.0%) | 0.27%, 3.2% | 1.0% | -1.0%, 3.1% | > 0.9 | > 0.9 |
Visit managed correctly based on prior SP studies | 48 (72%) | 59%, 82% | 236 (81%) | 76%, 85% | 9.2% | -3.4%, 22% | 0.13 | > 0.9 |
Symptoms and History-Taking | ||||||||
Number of history-taking questions asked | 11.0 (4.3) | 9.9, 12 | 10.5 (4.2) | 10.0, 11 | -0.53 | -1.7, 0.62 | 0.4 | > 0.9 |
Number of cardinal TB symptoms asked in history-taking (cough duration, blood in sputum, fever, night sweats, weight loss) | 3.39 (1.13) | 3.1, 3.7 | 3.26 (1.12) | 3.1, 3.4 | -0.13 | -0.43, 0.17 | 0.4 | > 0.9 |
Provider asked about cough duration | 64 (96%) | 87%, 99% | 289 (99%) | 97%, 100% | 3.5% | -2.6%, 9.5% | 0.14 | > 0.9 |
Provider asked about cough with sputum | 59 (88%) | 77%, 94% | 244 (84%) | 79%, 88% | -4.5% | -14%, 5.3% | 0.5 | > 0.9 |
Provider asked about sputum color | 33 (49%) | 37%, 62% | 121 (41%) | 36%, 47% | -7.8% | -22%, 6.3% | 0.3 | > 0.9 |
Provider asked about blood in sputum | 21 (31%) | 21%, 44% | 69 (24%) | 19%, 29% | -7.7% | -21%, 5.3% | 0.2 | > 0.9 |
Provider asked about cough intensity (number of times per day) | 25 (37%) | 26%, 50% | 122 (42%) | 36%, 48% | 4.5% | -9.3%, 18% | 0.6 | > 0.9 |
Provider asked about fever | 57 (85%) | 74%, 92% | 264 (90%) | 86%, 93% | 5.3% | -4.8%, 15% | 0.3 | > 0.9 |
Provider asked about fever type (severe, moderate, mild) | 29 (43%) | 31%, 56% | 94 (32%) | 27%, 38% | -11% | -25%, 2.8% | 0.11 | > 0.9 |
Provider asked about appetite | 28 (42%) | 30%, 54% | 130 (45%) | 39%, 50% | 2.7% | -11%, 17% | 0.8 | > 0.9 |
Provider asked about weight loss | 39 (58%) | 46%, 70% | 175 (60%) | 54%, 66% | 1.7% | -12%, 16% | > 0.9 | > 0.9 |
Provider asked about night sweats | 46 (69%) | 56%, 79% | 154 (53%) | 47%, 59% | -16% | -29%, -2.5% | 0.026 | > 0.9 |
Provider asked about wheezing | 19 (28%) | 18%, 41% | 55 (19%) | 15%, 24% | -9.5% | -22%, 3.1% | 0.12 | > 0.9 |
Provider asked about shortness of breath/difficulty breathing | 33 (49%) | 37%, 62% | 182 (62%) | 56%, 68% | 13% | -1.0%, 27% | 0.067 | > 0.9 |
Provider asked about chest pain | 23 (34%) | 23%, 47% | 73 (25%) | 20%, 30% | -9.3% | -23%, 4.0% | 0.2 | > 0.9 |
Provider asked if SP had taken any medications for current symptoms | 43 (64%) | 51%, 75% | 203 (70%) | 64%, 75% | 5.3% | -8.2%, 19% | 0.5 | > 0.9 |
Provider asked the name of the medications | 38 (57%) | 44%, 69% | 174 (60%) | 54%, 65% | 2.9% | -11%, 17% | 0.8 | > 0.9 |
Provider asked how long the SP had taken the medications | 12 (18%) | 10.0%, 30% | 47 (16%) | 12%, 21% | -1.8% | -13%, 9.2% | 0.9 | > 0.9 |
Provider asked if SP had taken any antibiotics for current symptoms | 2 (3.0%) | 0.52%, 11% | 46 (16%) | 12%, 21% | 13% | 6.0%, 20% | 0.010 | 0.9 |
Provider asked if SP takes long-term medications for other diseases | 0 (0%) | 0.00%, 6.8% | 9 (3.1%) | 1.5%, 6.0% | 3.1% | 0.18%, 6.0% | 0.3 | > 0.9 |
Provider asked about drug allergies | 40 (60%) | 47%, 71% | 177 (61%) | 55%, 66% | 0.91% | -13%, 15% | > 0.9 | > 0.9 |
Provider asked SP’s family/close contacts have similar symptoms | 17 (25%) | 16%, 38% | 114 (39%) | 33%, 45% | 14% | 0.92%, 26% | 0.051 | > 0.9 |
Provider asked about SP’s TB history | 4 (6.0%) | 1.9%, 15% | 28 (9.6%) | 6.6%, 14% | 3.6% | -3.9%, 11% | 0.5 | > 0.9 |
Provider asked about family history of TB | 14 (21%) | 12%, 33% | 66 (23%) | 18%, 28% | 1.7% | -10%, 13% | 0.9 | > 0.9 |
Provider asked if SP lives at home with children | 4 (6.0%) | 1.9%, 15% | 12 (4.1%) | 2.2%, 7.3% | -1.9% | -8.9%, 5.2% | 0.7 | > 0.9 |
Provider asked about anti-TB drug history | 1 (1.5%) | 0.08%, 9.1% | 9 (3.1%) | 1.5%, 6.0% | 1.6% | -2.8%, 6.0% | 0.8 | > 0.9 |
Provider asked about history of diabetes | 0 (0%) | 0.00%, 6.8% | 26 (8.9%) | 6.0%, 13% | 8.9% | 4.7%, 13% | 0.023 | > 0.9 |
Provider asked about history of HIV | 0 (0%) | 0.00%, 6.8% | 2 (0.7%) | 0.12%, 2.7% | 0.68% | -0.95%, 2.3% | > 0.9 | > 0.9 |
Provider asked about history of hypertension | 3 (4.5%) | 1.2%, 13% | 33 (11%) | 8.0%, 16% | 6.8% | -0.23%, 14% | 0.15 | > 0.9 |
Provider asked about other disease history | 8 (12%) | 5.7%, 23% | 35 (12%) | 8.6%, 16% | 0.05% | -8.6%, 8.7% | > 0.9 | > 0.9 |
Provider asked about alcohol consumption | 0 (0%) | 0.00%, 6.8% | 2 (0.7%) | 0.12%, 2.7% | 0.68% | -0.95%, 2.3% | > 0.9 | > 0.9 |
Provider asked about smoking status | 29 (43%) | 31%, 56% | 93 (32%) | 27%, 38% | -11% | -25%, 2.5% | 0.10 | > 0.9 |
Provider seemed to take note of the information provided by SP | 59 (88%) | 77%, 94% | 260 (89%) | 85%, 92% | 1.0% | -8.5%, 10% | > 0.9 | > 0.9 |
Physical Examinations Conducted | ||||||||
Number of exams conducted | 3.75 (1.74) | 3.3, 4.2 | 3.77 (1.54) | 3.6, 3.9 | 0.02 | -0.43, 0.48 | > 0.9 | > 0.9 |
Provider measured pulse rate | 46 (69%) | 56%, 79% | 218 (75%) | 69%, 79% | 6.0% | -7.1%, 19% | 0.4 | > 0.9 |
Provider measured temperature with thermometer | 17 (25%) | 16%, 38% | 193 (66%) | 60%, 71% | 41% | 28%, 53% | < 0.001 | < 0.001 |
Provider measured blood pressure | 56 (84%) | 72%, 91% | 254 (87%) | 82%, 91% | 3.4% | -7.2%, 14% | 0.6 | > 0.9 |
Provider conducted throat examination | 37 (55%) | 43%, 67% | 53 (18%) | 14%, 23% | -37% | -51%, -23% | < 0.001 | < 0.001 |
Provider conducted cervical lymph node examination | 18 (27%) | 17%, 39% | 38 (13%) | 9.5%, 18% | -14% | -26%, -1.6% | 0.008 | 0.7 |
Provider conducted chest examination with a stethoscope | 60 (90%) | 79%, 95% | 248 (85%) | 80%, 89% | -4.6% | -14%, 4.7% | 0.4 | > 0.9 |
Provider measured body weight | 17 (25%) | 16%, 38% | 90 (31%) | 26%, 37% | 5.4% | -7.2%, 18% | 0.5 | > 0.9 |
Provider measured body height | 0 (0%) | 0.00%, 6.8% | 7 (2.4%) | 1.1%, 5.1% | 2.4% | -0.27%, 5.1% | 0.4 | > 0.9 |
Tests and Examinations Recommended | ||||||||
Any diagnostic test | 48 (72%) | 59%, 82% | 234 (80%) | 75%, 84% | 8.5% | -4.1%, 21% | 0.2 | > 0.9 |
Any TB test (Chest X-ray/Sputum test) | 48 (72%) | 59%, 82% | 216 (74%) | 68%, 79% | 2.3% | -10%, 15% | 0.8 | > 0.9 |
Any TB sputum test | 19 (28%) | 18%, 41% | 86 (29%) | 24%, 35% | 1.1% | -12%, 14% | > 0.9 | > 0.9 |
Chest x-ray | 44 (66%) | 53%, 77% | 204 (70%) | 64%, 75% | 4.2% | -9.3%, 18% | 0.6 | > 0.9 |
Xpert | 0 (0%) | 0.00%, 6.8% | 3 (1.0%) | 0.27%, 3.2% | 1.0% | -1.0%, 3.1% | > 0.9 | > 0.9 |
Sputum microscopic examination/Acid Fast Bacilli test | 19 (28%) | 18%, 41% | 81 (28%) | 23%, 33% | -0.62% | -13%, 12% | > 0.9 | > 0.9 |
Sputum culture | 0 (0%) | 0.00%, 6.8% | 4 (1.4%) | 0.44%, 3.7% | 1.4% | -0.88%, 3.6% | 0.8 | > 0.9 |
Drug Sensitivity Testing | 0 (0%) | 0.00%, 6.8% | 1 (0.3%) | 0.02%, 2.2% | 0.34% | -0.67%, 1.4% | > 0.9 | > 0.9 |
Routine hematology test | 7 (10%) | 4.7%, 21% | 44 (15%) | 11%, 20% | 4.6% | -4.7%, 14% | 0.4 | > 0.9 |
Erythrocyte Sedimentation Rate | 3 (4.5%) | 1.2%, 13% | 17 (5.8%) | 3.5%, 9.3% | 1.3% | -5.2%, 7.9% | 0.9 | > 0.9 |
TB Serology test (IGRA, etc.) | 0 (0%) | 0.00%, 6.8% | 1 (0.3%) | 0.02%, 2.2% | 0.34% | -0.67%, 1.4% | > 0.9 | > 0.9 |
Diabetes test/glucose test | 2 (3.0%) | 0.52%, 11% | 4 (1.4%) | 0.44%, 3.7% | -1.6% | -6.8%, 3.6% | 0.7 | > 0.9 |
Other test | 4 (6.0%) | 1.9%, 15% | 9 (3.1%) | 1.5%, 6.0% | -2.9% | -9.8%, 4.0% | 0.4 | > 0.9 |
Type of facility recommended for TB test referral | ||||||||
This HCF | 16 (5.5%) | 3.3%, 8.9% | 5 (7.5%) | 2.8%, 17% | ||||
Private HCF not linked to NTP | 64 (22%) | 17%, 27% | 27 (40%) | 29%, 53% | ||||
Public HCF linked to NTP | 27 (9.2%) | 6.3%, 13% | 6 (9.0%) | 3.7%, 19% | ||||
Public HCF not linked to NTP | 8 (2.7%) | 1.3%, 5.5% | 0 (0%) | 0.00%, 6.8% | ||||
Private HCF linked to NTP | 2 (0.7%) | 0.12%, 2.7% | 1 (1.5%) | 0.08%, 9.1% | ||||
More than one HCF type | 32 (11%) | 7.7%, 15% | 5 (7.5%) | 2.8%, 17% | ||||
Not specified | 67 (23%) | 18%, 28% | 4 (6.0%) | 1.9%, 15% | ||||
Not applicable | 76 (26%) | 21%, 32% | 19 (28%) | 18%, 41% | ||||
Type of facility recommended for all test referrals | ||||||||
This HCF | 20 (6.8%) | 4.3%, 11% | 5 (7.5%) | 2.8%, 17% | ||||
Private HCF not linked to NTP | 56 (19%) | 15%, 24% | 26 (39%) | 27%, 52% | ||||
Public HCF linked to NTP | 29 (9.9%) | 6.9%, 14% | 6 (9.0%) | 3.7%, 19% | ||||
Public HCF not linked to NTP | 7 (2.4%) | 1.1%, 5.1% | 0 (0%) | 0.00%, 6.8% | ||||
Private HCF linked to NTP | 2 (0.7%) | 0.12%, 2.7% | 1 (1.5%) | 0.08%, 9.1% | ||||
More than one HCF type | 49 (17%) | 13%, 22% | 6 (9.0%) | 3.7%, 19% | ||||
Not specified | 71 (24%) | 20%, 30% | 4 (6.0%) | 1.9%, 15% | ||||
Not applicable | 58 (20%) | 16%, 25% | 19 (28%) | 18%, 41% | ||||
Diagnosis and Counseling | ||||||||
Working diagnosis given by the provider | ||||||||
Tuberculosis | 40 (60%) | 47%, 71% | 133 (46%) | 40%, 51% | ||||
Upper respiratory infection | 6 (9.0%) | 3.7%, 19% | 52 (18%) | 14%, 23% | ||||
No diagnosis given | 16 (24%) | 15%, 36% | 37 (13%) | 9.2%, 17% | ||||
Lower respiratory infection, unspecified | 1 (1.5%) | 0.08%, 9.1% | 37 (13%) | 9.2%, 17% | ||||
Lower respiratory infection, bronchitis | 2 (3.0%) | 0.52%, 11% | 14 (4.8%) | 2.7%, 8.1% | ||||
Allergy | 2 (3.0%) | 0.52%, 11% | 10 (3.4%) | 1.7%, 6.4% | ||||
Lower respiratory infection, COVID-19 | NA | NA | 7 (2.4%) | 1.1%, 5.1% | ||||
Heart disease | 0 (0%) | 0.00%, 6.8% | 1 (0.3%) | 0.02%, 2.2% | ||||
Occupational fatigue | 0 (0%) | 0.00%, 6.8% | 1 (0.3%) | 0.02%, 2.2% | ||||
Provider asked SP to return… | 51 (76%) | 64%, 85% | 164 (56%) | 50%, 62% | -20% | -33%, -7.3% | 0.004 | 0.4 |
…if symptoms persist or worsen | 22 (43%) | 30%, 58% | 83 (51%) | 43%, 58% | 7.5% | -9.4%, 24% | 0.4 | > 0.9 |
…to take medication | 7 (14%) | 6.2%, 27% | 6 (3.7%) | 1.5%, 8.2% | -10% | -21%, 1.1% | 0.022 | > 0.9 |
…to receive lab test results | 41 (80%) | 66%, 90% | 99 (60%) | 52%, 68% | -20% | -35%, -5.5% | 0.014 | > 0.9 |
…for another reason | 3 (5.9%) | 1.5%, 17% | 26 (16%) | 11%, 23% | 10.0% | 0.15%, 20% | 0.11 | > 0.9 |
Provider explained the duration of treatment given | 36 (54%) | 41%, 66% | 147 (50%) | 44%, 56% | -3.4% | -18%, 11% | 0.7 | > 0.9 |
Provider explained the importance of taking medicine regularly | 28 (42%) | 30%, 54% | 101 (35%) | 29%, 40% | -7.2% | -21%, 6.7% | 0.3 | > 0.9 |
Provider explained the importance of undergoing treatment to completion | 22 (33%) | 22%, 46% | 99 (34%) | 29%, 40% | 1.1% | -12%, 14% | > 0.9 | > 0.9 |
Provider explained the side effects that could arise from the prescribed medication | 5 (7.5%) | 2.8%, 17% | 15 (5.1%) | 3.0%, 8.5% | -2.3% | -10%, 5.4% | 0.7 | > 0.9 |
Provider explained cough etiquette | 5 (7.5%) | 2.8%, 17% | 13 (4.5%) | 2.5%, 7.7% | -3.0% | -11%, 4.6% | 0.5 | > 0.9 |
Provider explained the importance of quitting smoking | 16 (24%) | 15%, 36% | 52 (18%) | 14%, 23% | -6.1% | -18%, 6.0% | 0.3 | > 0.9 |
Provider advised SP to register for Indonesia national health insurance | 9 (13%) | 6.7%, 24% | 17 (5.8%) | 3.5%, 9.3% | -7.6% | -17%, 1.9% | 0.057 | > 0.9 |
Prescriptions | ||||||||
Provider prescribed and/or dispensed medication | 60 (90%) | 79%, 95% | 279 (96%) | 92%, 98% | 6.0% | -2.6%, 15% | 0.10 | > 0.9 |
Number of medications prescribed | 3.23 (1.01) | 3.0, 3.5 | 3.38 (0.96) | 3.3, 3.5 | 0.15 | -0.14, 0.43 | 0.3 | > 0.9 |
Provider prescribed non- ATT antibiotics | 49 (73%) | 61%, 83% | 198 (68%) | 62%, 73% | -5.3% | -18%, 7.5% | 0.5 | > 0.9 |
Cephalosporin and other beta lactam antibiotics | 17 (25%) | 16%, 38% | 121 (41%) | 36%, 47% | 16% | 3.3%, 29% | 0.022 | > 0.9 |
Penicillin | 12 (18%) | 10.0%, 30% | 17 (5.8%) | 3.5%, 9.3% | -12% | -23%, -1.6% | 0.002 | 0.2 |
Quinolones: ciprofloxacin, ofloxacin | 8 (12%) | 5.7%, 23% | 27 (9.2%) | 6.3%, 13% | -2.7% | -12%, 6.7% | 0.7 | > 0.9 |
Macrolide | 8 (12%) | 5.7%, 23% | 26 (8.9%) | 6.0%, 13% | -3.0% | -12%, 6.3% | 0.6 | > 0.9 |
Sulfonamide and trimethoprim | 1 (1.5%) | 0.08%, 9.1% | 3 (1.0%) | 0.27%, 3.2% | -0.47% | -4.1%, 3.1% | > 0.9 | > 0.9 |
Tetracycline | 0 (0%) | 0.00%, 6.8% | 1 (0.3%) | 0.02%, 2.2% | 0.34% | -0.67%, 1.4% | > 0.9 | > 0.9 |
Other antibiotics | 3 (4.5%) | 1.2%, 13% | 4 (1.4%) | 0.44%, 3.7% | -3.1% | -9.2%, 2.9% | 0.2 | > 0.9 |
Provider prescribed First-Line ATT antibiotics (Rifampicin, Isoniazid, Ethambutol, or Pyrazinamide) | 2 (3.0%) | 0.52%, 11% | 0 (0%) | 0.00%, 1.6% | -3.0% | -8.0%, 2.0% | 0.040 | > 0.9 |
Provider prescribed Second Line ATT antibiotics (Levofloxacin) | 3 (4.5%) | 1.2%, 13% | 31 (11%) | 7.4%, 15% | 6.1% | -0.86%, 13% | 0.2 | > 0.9 |
Provider prescribed anti-inflammation medication (Corticosteroids) | 21 (31%) | 21%, 44% | 78 (27%) | 22%, 32% | -4.6% | -18%, 8.5% | 0.5 | > 0.9 |
Provider prescribed vitamin | 7 (10%) | 4.7%, 21% | 110 (38%) | 32%, 44% | 27% | 17%, 37% | < 0.001 | 0.003 |
Provider prescribed symptomatic/over the counter medication | 59 (88%) | 77%, 94% | 207 (71%) | 65%, 76% | -17% | -27%, -6.9% | 0.006 | 0.5 |
Provider dispensed drug with no label | 5 (7.5%) | 2.8%, 17% | 48 (16%) | 12%, 21% | 9.0% | 0.46%, 17% | 0.094 | > 0.9 |
Costs | ||||||||
Total cost of entire visit (IDR) | 119,413 (84,544) | 98,791, 140,035 | 121,869 (75,417) | 113,182, 130,555 | 2,456 | -19,853, 24,765 | 0.8 | > 0.9 |
Total cost of entire visit (USD) | 8.30 (5.90) | 6.90, 9.80 | 8.40 (5.20) | 7.80, 9.00 | 0.13 | -1.40, 1.70 | 0.9 | > 0.9 |
Provider tests and referrals
Prescriptions
COVID-19 questions
Are private providers in Bandung correctly managing people with TB symptoms?
Which types of private providers are more likely to correctly manage people with TB symptoms?
Characteristic | Adjusted odds ratio (aOR)a | 95% Confidence Interval (CI)a | P value |
---|---|---|---|
Provider characteristics
| |||
Provider age increase of 5 yearsb | 0.76 | 0.67, 0.87 | < 0.001 |
Provider sex = Malec (reference = Female) | 0.52 | 0.27, 1.01 | 0.052 |
Provider qualification = Specialistd (reference = General Practitioner) | 0.84 | 0.22, 3.21 | 0.8 |
Provider received training on TB managemente (reference = no training) | 0.95 | 0.53, 1.71 | 0.9 |
Provider diagnoses at least one TB case per monthf (reference = no diagnoses) | 0.88 | 0.50, 1.56 | 0.7 |
Facility characteristics
| |||
Facility type = Solo Practiceg (reference = Clinic/Hospital) | 0.78 | 0.32, 1.87 | 0.6 |
Sputum examination available at facilityh (reference = sputum examination not available) | 0.56 | 0.17, 1.84 | 0.3 |
Visit characteristics
| |||
Visit length increase of 5 mini | 1.05 | 0.84, 1.31 | 0.7 |
Visit cost increase of $5 (USD)h | 0.81 | 0.59, 1.10 | 0.2 |
Number of questions asked in history-takinge (continuous) | 1.07 | 1.02, 1.13 | 0.004 |
Number of cardinal TB symptoms asked in visite (continuous) | 2.78 | 1.82, 4.23 | < 0.001 |
Provider prescribed non-ATT antibiotice (reference = did not prescribe non-ATT antibiotic) | 0.56 | 0.32, 1.00 | 0.051 |
Provider prescribed steroidse (reference = did not prescribe steroids) | 0.74 | 0.40, 1.37 | 0.4 |
What is the extent of changes in clinical practices in TB care during the COVID-19 pandemic?
Binary Outcomes
| Na | aORb | 95% CIc | P-valued |
NTP 2016 Guidelines | 340 | 0.97 | 0.44, 2.14 | > 0.90 |
Correct management based on prior SP studies | 340 | 0.74 | 0.00, 113 | > 0.90 |
Recommendation for any TB test | 340 | 1.09 | 0.53, 2.24 | > 0.90 |
Recommendation for chest X-ray | 340 | 1.35 | 0.67, 2.71 | > 0.90 |
Recommendation for any sputum test | 340 | 0.73 | 0.33, 1.60 | > 0.90 |
Prescribed steroids | 340 | 0.74 | 0.34, 1.58 | > 0.90 |
Prescribed other non-ATT antibiotics | 340 | 0.70 | 0.35, 1.42 | > 0.90 |
Checked SP’s temperature | 340 | 8.05 | 2.96, 21.9 | < 0.001 |
Conducted throat examination | 340 | 0.16 | 0.06, 0.41 | 0.002 |
Examined SP’s lymph nodes | 340 | 0.41 | 0.18, 0.94 | 0.43 |
Referral to public DOTS | 340 | 0.70 | 0.27, 1.83 | > 0.90 |
Request to come back | 340 | 0.43 | 0.20, 0.94 | 0.43 |
Linear Outcomes
| Na |
Beta
| 95% CIc | P-valued |
Length of visit (minutes) | 340 | -0.32 | -2.5, 1.9 | > 0.90 |
Number of questions asked | 340 | -0.91 | -2.2, 0.37 | > 0.90 |
Number of exams | 340 | 0.01 | -0.52, 0.54 | > 0.90 |
Cost of visit (USD)e | 340 | 1.6 | 0.39, 2.9 | 0.15 |