Patient pathway analysis and care cascades: indicators and data sources
| Indicators | Descriptions and parameters | Sources |
| Patients pathway analysis (PPA) | ||
| 1. Place of initial care-seeking. | Place of initial care-seeking among those with cough ≥2 weeks or haemoptysis. | National TB prevalence survey (2011) |
| Urban population and per cent of total population in Cambodia. | United Nations Population Fund (2014)60 | |
| 2. Coverage of TB diagnostic services. | The proportion of health facilities (national hospital, provincial hospital, referral hospital and health centres) with TB diagnostic modalities (microscopes, GeneXpert instrument, culture). | NTP (2019) |
| 3. Access to TB diagnostic services at the place of initial care-seeking. | The proportion of those who sought care and accessed TB diagnostic services at their initial visit. | Product of core metric 1 and 2 |
| 4. Coverage of TB treatment services. | The proportion of health facilities (national hospital, provincial hospital, referral hospital and health centres) that provide treatment services. | NTP (2019) |
| 5. Access to TB treatment at the place of initial care-seeking. | The proportion of those who sought care and accessed a facility with TB treatment services at their initial visit. | Product of core metric 1 and 4 |
| 6. Notification location. | The estimated proportion of people with TB enrolled in treatment and notified to the national programme. | WHO and the NTP (2019) |
| 7. Treatment outcome. | The proportion of people with TB enrolled in treatment and completed TB treatment/were successfully treated. | WHO and the NTP (2019) |
| Care cascade for TB disease | ||
| 1. Estimated incidence of TB. | Total number of incident TB cases (all-forms) in 2019. | WHO global TB database 202016 |
| 2. Accessed TB tests. | ||
| The estimated number of people who reached TB diagnostic facilities and were evaluated for TB. Several key parameters (next column) were accounted for (by the different forms of TB) in estimating the total number. | Smear or GeneXpert positive: | |
| The proportion of individuals tested using smear microscopy (%). | NTP | |
| The proportion of individuals tested using GeneXpert (%). | NTP | |
| The proportion of individuals who failed to provide a second sputum specimen (%). | WHO policy statement 201117 | |
| The incremental yield of a second sputum smear (%). | Mase et al 200718 | |
| Smear negative and previously treated excluding relapse cases: | ||
| The ratio of smear-positive to negative. | NTP | |
| The ratio of GeneXpert-positive to negative. | NTP | |
| Sensitivity of smear microscopy (%). | National TB prevalence survey 2011 | |
| Sensitivity of GeneXpert (%). | Steingart et al 201419 | |
| Extrapulmonary TB: | ||
| The average proportion of undiagnosed smear-positive and smear-negative TB (%). | Average of the % of undiagnosed smear-positive and the % of undiagnosed smear-negative (online supplemental materials) | |
| 3. Diagnosed with TB. | ||
| The estimated number of individuals diagnosed with TB in 2019. Back calculated using the number of people registered in TB treatment by accounting for pre-treatment loss to follow-up rate. | Pre-treatment loss to follow-up rate (%). | Mao et al 201220 |
| 4. Registered in treatment. | Total number of people with TB (all-forms: new and relapse by smear status, previously treated excluding relapse cases, and extrapulmonary TB) registered in treatment in 2019. | WHO global TB database 202016 |
| 5. Treatment success. | Total number of people with TB who achieved treatment success in 2019. | NTP |
| 6. Recurrence-free survival. | The proportion of TB survivors who remained alive and TB-free 1 year after completing TB treatment (%). | Primary data |
| Care cascade for TPT (PLHIV) | ||
| 1. Estimated number of PLHIV. | PLHIV (all ages). | UNAIDS23 |
| 2. Number of PLHIV who know their HIV status. | PLHIV who know their status. | UNAIDS23 |
| 3. Number of PLHIV on antiretroviral therapy who are eligible for TPT. | PLHIV who are eligible for TPT. | National HIV Programme |
| 4. Number of PLHIV who initiated TPT. | PLHIV who initiated TPT (any course). | National HIV Programme |
| 5. Number of PLHIV who initiated TPT and completed the course. | PLHIV who initiated and completed TPT (any course). | National HIV Programme |
| Care cascade for TPT (household contacts <5 years) | ||
| 1. Estimated number of household contacts (children <5 years). | Point estimate of the annual contacts (children aged <5) needing evaluation. | Yuen et al 201624 |
| 2. Estimated number of household contacts (children <5 years) evaluated for TB disease and infection. | The proportion of household contact (children <5) who were evaluated for TB disease and infection* (%). | TPT programme database (COMMIT) |
| 3. Estimated number of children <5 years who were TB negative and eligible for TPT. | The proportion of household contact (children <5) who were eligible for and initiated TPT (%). | WHO global TB database 202016 |
| 4. Number of children <5 years who initiated TPT. | Number of children aged <5 who initiated TPT. | National TB Programme and WHO |
| 5. Estimated number of children <5 years who initiated TPT and completed the course. | The proportion of household contact (children <5) who completed TPT (%). | TPT programme database (COMMIT) |
| Care cascade for TPT (household contacts all ages) | ||
| 1. Estimated number of household contacts (all ages). | Number of persons with new and relapse bacteriologically-confirmed pulmonary TB. | WHO global TB database 202016 |
| Estimated average household size. | Demographic and health survey 201426 | |
| 2. Number of household contacts (all ages) evaluated for TB disease and infection. | Number of household contacts (all ages) evaluated for TB disease and infection.* | National TB Programme and WHO |
| 3. Estimated number of household contacts (all ages) who were TB negative and eligible for TPT. | The proportion of household contact (all ages) who were healthy and eligible for TPT (%). | National TB Programme |
| 4. Number of household contacts (all ages) who initiated TPT. | Number of household contacts (all ages) who initiated TPT. | National TB Programme |
| 5. Estimated number of household contacts (all ages) who initiated TPT and completed the course. | The proportion of household contact (children<5) who completed TPT (%). | TPT programme database (COMMIT) |
*Evaluation to rule of TB disease (clinical symptoms-based screening±chest radiography), and potential contraindications to TPT, such as liver disease and known allergies to TPT
COMMIT, Community Mobilization Initiatives to End TB (USAID funded project in Cambodia); NTP, National TB programme; PLHIV, people living with HIV; TB, tuberculosis; TPT, TB preventive treatment; UNAIDS, Joint United Nations Programme on HIV/AIDS.