Post-Tuberculosis Lung Damage Amongst Pulmonary Tuberculosis Survivors in East Africa (PTLD)

Tuberculosis (TB) is one of the major public health challenges across the globe, with an estimated 10 million new cases occurring worldwide, in 2018. Progress has been made in recent years to improve access to and quality of treatment, consequently decreasing the number of people lost to illness.  It is currently approximated that more than 80 per cent of patients survive pulmonary TB (pTB) treatment (cure or treatment completion). However, there is increasing evidence of multimorbidity amongst survivors, especially with residual lung damage. Other sequelae faced by TB affected households may include ongoing socio-economic challenges, mental illness and stigma. Survivors of pTB may benefit from ongoing care. However, there is little evidence on how this should be done, or what models of post-TB care could look like.

PTLD built on existing collaborations between the Liverpool School of Tropical Medicine (LSTM) and the African Institute for Development Policy (AFIDEP) to explore patient-centred models of post-TB care in Malawi and Kenya. The initiative aimed at engaging stakeholders in discussions, through workshops and interviews, toward improving the healthcare of tuberculosis survivors, making use of collaborative approaches with key stakeholders in order to achieve the following specific objectives:

1. To engage in dialogue with patient, clinical, administrative, research and policy stakeholders within each country to describe locally appropriate potential models of post-TB care
2. To describe health system barriers to implementation of each model and identify the pilot and feasibility data required to inform prioritisation of preferred models
3. To develop wider relationships with policy and academic institutions in Kenya and Malawi in a bid to strengthen design and delivery of the health systems and policy research agenda in the region.

• Individual interviews: The key informants were purposively selected to provide diverse perspectives from influential individuals in key positions whose responsibilities require that they track a broad range of health policy and evidence issues, including those with specific focus on TB. Individual interviews will be held both before the stakeholder workshops, to shape the content to be included in the workshops, and after where additional perspectives and opinions will be sought.
• Stakeholder Workshops: To engage in dialogue with patient, clinical, administrative, research and policy stakeholders, at least two workshops will be held in Kenya and Malawi. These discussions were cover; appropriate potential models for post pTB care, a description of health system barriers to implementation of proposed models, and identifying pilot and feasibility data required to inform prioritisation of preferred models.

The results of the stakeholder engagement exercises were reported through presentations at local, national and international conferences or policy/science platforms. The results were shared as publications in peer-reviewed journals. These findings and lessons learned were also shared with the various stakeholders involved in the consultation workshops through official workshop reports. For policymakers the information was shared in the form of a policy brief written by the study team at the end of this project, for national use.

The Liverpool School of Tropical Medicine (LSTM) and AFIDEP were partners and the National Institute for Health Research (NIHR) was the funder.