A Quality of Care Evaluation to Identify Priorities for Improving Tuberculosis Care in Ireland

Tuberculosis (TB) is a preventable and treatable disease that is a major cause of global morbidity and mortality. Ireland is a high-income country which had an incidence of 5.6 cases of TB per 100,000 of population in 2019. Despite a low and declining incidence, TB care in Ireland must be improved if disease elimination (defined as an incidence of less than one case per million of population) is to be achieved. Internationally, there is a growing consensus that if TB is to be eliminated, programmatic management of latent TB infection (LTBI) is necessary, particularly in countries with a low disease incidence. Programmatic management involves identifying people or groups with a high prevalence of LTBI or risk of TB reactivation and engaging them in preventive care to reduce their individual or collective risk of TB disease. Once care is accessed, it must be of high-quality if patients with and at risk of TB disease are to avoid TB-related morbidity, mortality, and onward disease transmission to others. However, quality cannot be assumed, it must be defined, measured, and continually improved. This research evaluated the quality of care provided by a TB service in Ireland according to a quality framework and measures and benchmarked it against outcomes reported in the literature using international standards of TB care. The literature was systematically reviewed to identify the gaps in LTBI epidemiological and cascade of care research in Ireland. The direct and indirect cost of TB disease was in Ireland was also estimated. The research identified 21 areas where quality of TB care and LTBI research in Ireland should be improved and 23 recommendations to do so were made. The research identified the need to perform local and national cascade of LTBI care evaluations and research studies assessing the prevalence of LTBI and risk of TB reactivation in people in specific at-risk groups. This is needed to expand and scale programmatic LTBI management through local TB services. Patients with TB had a prolonged time from symptom onset to presentation to health care services, resulting in a high dependency on acute care pathways. The total annual cost of TB disease nationally was estimated at €15,906,424 in 2019. This research demonstrates the potential value a quality management approach has for TB elimination efforts in Ireland. Consideration should be given to the development of a national TB quality management programme as part of a funded national TB elimination strategy and programme.