03043nas a2200385   4500000000100000008004100001260001200042653001800054653002900072653001900101653003000120653001800150100001300168700001500181700001200196700001300208700001200221700001300233700001300246700001100259700001400270700001900284700001300303700001600316700001300332700001300345700001300358700001400371245012800385856005800513300000900571490000600580520205700586022001402643       2024                            d  c01/202410aHealth Policy10aHealth Services Research10aHealth systems10aHealth systems evaluation10aPublic health1 aKollie K1 aTheobald S1 aJones L1 aKpadeh O1 aNallo G1 aBorbor D1 aTaylor M1 aDean L1 aPhillip M1 aGodwin-Akpan T1 aMensah D1 aWickenden A1 aKollie J1 aRogers E1 aZaizay Z1 aStewart M00aMultimethod evaluation of health services integration for neglected tropical diseases requiring case management in Liberia.  uhttps://gh.bmj.com/content/bmjgh/9/1/e012599.full.pdf  a1-140 v93 a<p><strong>Introduction: </strong>The WHO neglected tropical disease (NTD) roadmap stresses the importance of integrating NTDs requiring case management (CM) within the health system. The NTDs programme of Liberia is among the first to implement an integrated approach and evaluate its impact.</p>

<p><strong>Methods: </strong>A retrospective study of three of five CM-NTD-endemic counties that implemented the integrated approach was compared with cluster-matched counties with non-integrated CM-NTD. We compared trends in CM-NTD integrated versus non-integrated county clusters. We conducted a pre-post comparison of WHO high-level outcomes using data collected during intervention years compared with baseline in control counties. Changes in health outcomes, effect sizes for different diseases and rate ratios with statistically significant differences were determined. Complementary qualitative research explored CM-NTD stakeholders' perceptions, analysed through the framework approach, which is a transparent, multistage approach for qualitative thematic interdisciplinary data analysis.</p>

<p><strong>Results: </strong>The detection rates for all diseases combined improved significantly in the intervention compared with the control clusters. Besides leprosy, detection rates improved with large effects, over fourfold increase with statistically significant effects for individual diseases (p&lt;0.000; 95% CI 3.5 to 5.4). Access to CM-NTD services increased in integrated counties by 71 facilities, compared with three facilities in non-integrated counties. Qualitative findings highlight training and supervision as inputs underpinning increases in case detection, but challenges with refresher training, medicine supply and incentives negatively impact quality, equity and access.</p>

<p><strong>Conclusions: </strong>Integrating CM-NTDs improves case detection, accessibility and availability of CM-NTD services, promoting universal health coverage. Early case detection and the quality of care need further strengthening.</p>
  a2059-7908