{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T02:18:38Z","timestamp":1768529918580,"version":"3.49.0"},"reference-count":23,"publisher":"International Union Against Tuberculosis and Lung Disease","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJTLD Open"],"accepted":{"date-parts":[[2025,8,25]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>SUMMARY<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Drug-resistant TB (DR-TB) care coordination in Nigeria remains largely centralised, negatively impacting pre-treatment loss-to-follow-up (PTLTFU) and time-to-treatment initiation. We piloted a multi-faceted intervention and documented how the decentralisation of DR-TB services affected treatment enrolment and time-to-treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A quasi-experimental study was conducted in Southern Nigeria. Multi-level intervention consisting of eight components was implemented in the intervention states over a 15-month period. Data were collected using desk review proformas and analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      At baseline, comparable proportions of people with DR-TB initiated treatment (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 3.150,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.076). Following decentralisation, a higher proportion (79.1%) of diagnosed persons with DR-TB in the intervention states were enrolled into treatment compared with the control states, 66.0% (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      = 15.232,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001). There was a significant reduction in PTLTFU in the intervention states from 39.5% to 20.9% (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.001) while PTLTFU increased from 31.9% to 34.0% (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.689) in the control states. The median time-to-treatment initiation decreased from 17 days (interquartile range [IQR]: 10.0\u201332.0) at baseline to 14 days (IQR: 9.0\u201325.2) post-intervention. In the control states, median time-to-treatment initiation decreased from 21 days (IQR: 13.0\u201335.3) at baseline to 15 days (8.0\u201336.0) post-intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Decentralising DR-TB services significantly reduced the diagnosis\u2013enrolment gap and time-to-treatment initiation. Our findings provide contextual evidence for the expansion of decentralised services in Nigeria.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5588\/ijtldopen.25.0412","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T11:08:01Z","timestamp":1765796881000},"page":"757-762","source":"Crossref","is-referenced-by-count":0,"title":["Decentralising drug-resistant TB treatment initiation services"],"prefix":"10.5588","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8366-8027","authenticated-orcid":true,"given":"N.","family":"Murphy-Okpala","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Eze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.N.","family":"Orabueze","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Ezenwosu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Nwafor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Ekeke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.","family":"Ezeakile","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.N.","family":"Chukwu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Matiku","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Meka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Njoku","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Kirubi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Iyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Ossai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O.","family":"Chijioke-Akaniro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Creswell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3554","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"2026011502222401000_2.12.757.1","unstructured":"World Health Organization . Global tuberculosis report. Geneva: WHO, 2023."},{"key":"2026011502222401000_2.12.757.2","unstructured":"World Health Organization . The global health observatory. Geneva: WHO, 2025. https:\/\/www.who.int\/data\/gho\/data\/indicators\/indicator-details\/GHO\/confirmed-cases-of-rr--mdr-tb."},{"key":"2026011502222401000_2.12.757.3","unstructured":"Stop TB Partnership . UNHLM on TB key targets and commitments [Internet]. Geneva, Switzerland: Stop TB Partnership, 2022. https:\/\/www.stoptb.org\/advocacy-and-communications\/unhlm-tb-key-targets-and-commitments."},{"issue":"12","key":"2026011502222401000_2.12.757.4","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.3390\/pathogens10121568","article-title":"Provision of decentralized TB care services: a detect\u2013treat\u2013prevent strategy for children and adolescents affected by TB","volume":"10","author":"Zawedde-Muyanja","year":"2021","journal-title":"Pathogens"},{"key":"2026011502222401000_2.12.757.5","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.17.193375"},{"issue":"7","key":"2026011502222401000_2.12.757.6","doi-asserted-by":"crossref","first-page":"e0181238","DOI":"10.1371\/journal.pone.0181238","article-title":"Treatment initiation among persons diagnosed with drug resistant tuberculosis in Johannesburg, South Africa","volume":"12","author":"Evans","year":"2017","journal-title":"PLoS One"},{"key":"2026011502222401000_2.12.757.7","unstructured":"Department of Health . Multi-drug resistant tuberculosis: a policy framework on decentralised and deinstitutionalised management for South Africa. Tshwane, South Africa: Department of Health, 2019. https:\/\/www.health.gov.za\/wp-content\/uploads\/2020\/11\/policy-framework-on-decentralised-management-of-mdr-tb-may-2019_compressed.pdf."},{"issue":"1","key":"2026011502222401000_2.12.757.8","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s41256-016-0010-y","article-title":"Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis","volume":"1","author":"Williams","year":"2016","journal-title":"Glob Health Res Policy"},{"issue":"2","key":"2026011502222401000_2.12.757.9","doi-asserted-by":"crossref","first-page":"e0318274","DOI":"10.1371\/journal.pone.0318274","article-title":"Enhancing programmatic scale-up: applying the consolidated framework for implementation research to evaluate decentralized drug-resistant tuberculosis services in Southern Nigeria","volume":"20","author":"Murphy-Okpala","year":"2025","journal-title":"PLoS One"},{"key":"2026011502222401000_2.12.757.10","doi-asserted-by":"publisher","DOI":"10.1093\/inthealth\/ihu055"},{"key":"2026011502222401000_2.12.757.11","unstructured":"National Population Commission . Population and housing census, priority table. Abuja, Nigeria: National Population Commission, 2006. https:\/\/catalog.ihsn.org\/index.php\/catalog\/3340\/download\/48521."},{"key":"2026011502222401000_2.12.757.12","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.124800"},{"key":"2026011502222401000_2.12.757.13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002238"},{"issue":"1","key":"2026011502222401000_2.12.757.14","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1186\/s12913-018-3762-x","article-title":"Impact of Xpert MTB\/RIF and decentralized care on linkage to care and drug-resistant tuberculosis treatment outcomes in Johannesburg, South Africa","volume":"18","author":"Evans","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"2026011502222401000_2.12.757.15","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3039-3"},{"issue":"1","key":"2026011502222401000_2.12.757.16","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1186\/s12889-018-5468-8","article-title":"Performance of centralized versus decentralized tuberculosis treatment services in Southern Brazil, 2006\u20132015","volume":"18","author":"Scheffer","year":"2018","journal-title":"BMC Public Health"},{"issue":"14","key":"2026011502222401000_2.12.757.17","doi-asserted-by":"crossref","first-page":"6423","DOI":"10.3390\/ijerph20146423","article-title":"Time-to-treatment initiation in a decentralised community-care model of drug-resistant tuberculosis management in the OR Tambo District Municipality of South Africa","volume":"20","author":"Iruedo","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"2026011502222401000_2.12.757.18","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.ijtb.2017.08.031","article-title":"Cost effectiveness of decentralised care model for managing MDR-TB in India","volume":"65","author":"John","year":"2018","journal-title":"Indian J Tuberc"},{"key":"2026011502222401000_2.12.757.19","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.11.0401"},{"key":"2026011502222401000_2.12.757.20","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02259-17"},{"key":"2026011502222401000_2.12.757.21","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-17-00345"},{"issue":"8","key":"2026011502222401000_2.12.757.22","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1093\/heapol\/czac038","article-title":"Re-evaluating the merits of decentralization as a core strategy for effective delivery of drug-resistant tuberculosis care in Pakistan","volume":"37","author":"Khan","year":"2022","journal-title":"Health Policy Plan"},{"issue":"1","key":"2026011502222401000_2.12.757.23","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s13690-025-01672-7","article-title":"The effects of decentralisation on patient and service outcomes: a case of the 2018 decentralisation of multidrug-resistant tuberculosis in Zambia","volume":"83","author":"Matenga","year":"2025","journal-title":"Arch Public Health"}],"container-title":["IJTLD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.5588\/ijtldopen.25.0412","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T10:25:08Z","timestamp":1768472708000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.theunion.org\/lookup\/doi\/10.5588\/ijtldopen.25.0412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":23,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,1]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.5588\/ijtldopen.25.0412"],"URL":"https:\/\/doi.org\/10.5588\/ijtldopen.25.0412","relation":{},"ISSN":["3005-7590"],"issn-type":[{"value":"3005-7590","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}