Diffusion of global policies for management of multidrug-resistant tuberculosis in high-burden countries: A secondary data analysis

• Main Author: Gonzalez Angulo, Lice Yulieth
• Format: Dissertation
• Language: English

The diffusion of global policies for detection of multidrug-resistant tuberculosis (MDR-TB) and its treatment in high-burden countries is not yet fully described in the literature. Evaluating the status of policy diffusion from the global to the national level can be helpful in planning for future policy development and strategies for vulnerable settings. Policies for management and care of MDR-TB have been issued and disseminated through a multitude of channels. However, the uptake of such policies has been slow, despite the urgent need for public health programmes and national authorities to provide MDR-TB patients with evidence-based interventions that may improve their quality of life. The adoption of policies or their key components appears to be falling behind in many countries. Understanding the status of policy diffusion, especially in high MDR-TB burden settings, can provide some knowledge about the challenges for diffusion of global MDR-TB policies. This study used the diffusion of innovation theory as a lens to understand and illustrate the diffusion of global policies for diagnosis and treatment of MDR-TB from 2010 to 2015. The aim was to evaluate the current status of the diffusion process, and serve as a proxy to estimate the diffusion of newer policies such as the introduction of the World Health Organization (WHO)-recommended shorter MDR-TB regimen and implementation of new TB drugs. This study did not examine a government’s or an adopter’s decision to implement, but instead focused on the status, time-to-adopt and determinants of policy adoption. Multilevel and Cox proportional hazards modelling were used to assess policy diffusion of drug-susceptibility testing (DST) and provision of treatment for MDR-TB cases. Overall, the findings of this study indicate that the diffusion of these policy components is occurring at a slow pace; however, although the time-to-adoption was difficult to estimate, the diffusion rate of MDR-TB treatment appears to be increasing over time. Estimated number of HIV-associated TB and regional components appeared to be determinants of the diffusion of DST and MDR-TB treatment.