INT J TUBERC LUNG DIS 22(2):133–138
Q 2018 The Union
http://dx.doi.org/10.5588/ijtld.17.0608
People- and patient-centred care for tuberculosis: models of care
for tuberculosis
A. Odone,*† B. Roberts,* M. Dara,‡ M. van den Boom,‡ H. Kluge,‡ M. McKee*
*Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK;
†
University Vita-Salute San Raffaele, Milan, Italy; ‡World Health Organization Regional Office for Europe,
Copenhagen, Denmark
S E T T I N G : The first pillar in the World Health Organi-
sation’s (WHO’s) End TB strategy is ‘Integrated, patient-
centred tuberculosis (TB) care and prevention’. Howev-
er, what are patient- and people-centred care, and why
are they important for TB care and prevention?
O B J E C T I V E A N D R A T I O N A L E : To define the concept
of patient-centred care, the rationale for it, and its
evolution into people-centred care; and to explore
evidence on whether people-centred approaches work
for TB and present key areas where continuous efforts
are needed to support their implementation.
R E S U LT S : Based on the reasoning and the evidence
presented, we propose four areas where further action is
THE FIRST PILLAR in the World Health Organiza-
tion’s (WHO’s) End TB strategy is ‘Integrated,
patient-centred tuberculosis (TB) care and preven-
tion’.1 This is an aspiration that few could argue with.
Would anyone seek care that is fragmented, and
where the patient is peripheral to the organisation of
the health care system? Yet, in reality, this is the
situation that exists in many countries, as TB patients
frequently fall through gaps between different levels
of care, between the prison and civilian health care
services, or through gaps in social safety nets.2–4 The
inevitable result is failure to cure what is an eminently
treatable disease or, worse, the emergence of multi-
drug resistance, arguably an indicator of a system that
has failed to achieve integration and patient-centred-
ness. Clearly, there is a gap between aspiration and
implementation. We begin first by asking what
patient-centredness really means and why it is
important in the management of TB.
WHAT IS PATIENT-CENTRED CARE?
Some of the earliest references to patient-centred care
contrasted it with the then dominant paradigm in
medicine, which generally consisted of a fragmented
Correspondence to: Martin McKee, London School of Hygiene & Tropical Medicine, 15–17 Tavistock Place, London
WC1H 9SH, UK. e-mail: Martin.McKee@lshtm.ac.uk
Article submitted 30 August 2017. Final version accepted 5 October 2017.
PERSPECTIVE
SUMMARY
needed to ensure that people-centred TB care and
prevention can achieve their potential: 1) reaching
consensus on definitions and terminology; 2) strength-
ening research; 3) using and evaluating new technology;
and 4) nurturing country leadership and advocacy.
C O N C L U S I O N : Integrated, people-centred TB care and
prevention should be a guiding light for all those
involved in the quest to eliminate TB. However, much
still needs to be done to bridge the gaps between the
potential and actual performance of national pro-
grammes.
K E Y W O R D S : models of care; people-centredness
series of ‘illness-oriented’ approaches. Patients were
defined in terms of their diseases, rather than their
needs and expectations,5 a situation exemplified by
phrases such as ‘the appendix in bed 3’. Although
some of the earliest references came from nursing
practice and education,6 patient-centred health care
received impetus from English and American psychi-
atrists who,7–9 with ‘patient-centred’ psychotherapy,
called on professionals to adopt the patient’s perspec-
tive, rather than seeing them as just another
manifestation of pathology. Engel thus advocated a
biopsychological model that ‘[took] into account the
patient, the social context in which he (she) lives, and
the complementary system devised by society to deal
with the disruptive effects of illness’.9
It has, however, been difficult to agree on a single
definition for ‘patient-centred care’.10 Instead, re-
searchers have viewed it as comprising four key
attributes.10,11 First, it is holistic, seeing and valuing
the patient as a whole, while addressing his/her often
multiple needs, understanding the context that he/she
inhabits and taking into account his/her physical,
cognitive and psychological functioning. Second, it
should be individualised, reflecting each patient’s
unique needs, preferences, personality and health
134 The International Journal of Tuberculosis and Lung Disease
concerns. Third, it should be empowering, recognis-
ing patients as active consumers. Finally, it should be
respectful, encouraging informed decision-making
and self-determination.
These attributes, if present in personal, profession-
al and organisational relationships, will lead to
patient-centred models of care at the interface
between the patient and the health care worker, as
well as at the service delivery and health systems
levels.12 In terms of patient-health care worker
relationship, the practice of patient-centredness
involves, for example, an examination of the patient’s
main reason for visiting the health care facility, his/
her concerns and need for information, to work with
him/her to gain an integrated understanding of his/her
world, including his/her emotional needs and life
issues, finding common ground on the nature of his/
her problem and reaching mutual agreement on its
management.13,14 At the service delivery and health
system level, patient-centred care involves re-orient-
ing service delivery and health systems to enable
health care to be coordinated, with input from other
sectors, and integrating the various health services, so
that continuity of care is achieved across diverse
settings and patients are actively involved in the
process.
FROM PATIENT- TO PEOPLE-CENTRED CARE
Although often used interchangeably, the concept of
‘people-centred care’ has emerged more recently.15,16
As with patient-centred care, people-centred care
takes a holistic approach to patients, viewing them as
individuals with multiple concerns, attributes and,
often, conditions. However, people-centred care goes
further, in that it involves an understanding of not just
what defines him/her as a patient but also his/her
social, economic and cultural environment. People-
centred care extends the concept of patient-centred-
ness to include not only afflicted individuals but also
their families and communities.15–17 This concept is
now firmly embedded in a range of international
policy frameworks, such as Health 2020, the basis of
health policies in the WHO European Region, which
includes people-centred health systems (along with
enhanced public health capacity) as one of its four
priority areas.18 People-centred health systems are
also at the heart of the European Framework for
Action on Integrated Health Service Delivery.19
THE RATIONALE FOR INTRODUCING A PEOPLE-
CENTRED APPROACH INTO THE TUBERCULOSIS
POLICY AGENDA
The characteristics of TB make it especially suitable
for a people-centred approach. It has long been
recognised that TB prevention should address a
complex mix of biological and social determinants.
TB management is also complex, requiring an
understanding of the characteristics of the mycobac-
terium (such as whether it is resistant to drugs), of the
patient (e.g., immune status, co-existing conditions,
adherence to treatment, socio-economic status, per-
ceptions and preferences) and his/her community
(such as family support or housing quality).
A 2013 editorial in this Journal bore the title
‘Universal patient-centred care: can we achieve it?’,
although, arguably, it went further to embrace
people-centred care. The author noted that ‘it is
essential to recognise that TB patients often face
challenges beyond their disease, and that these
challenges must be addressed in order to provide
accessible diagnosis, treatment and care’.20 This
would ensure better adherence to anti-tuberculosis
treatment and empower health-educated patients,
who would feel encouraged by effective psychosocial
support.21
Patients with TB often have comorbidities, includ-
ing non-communicable diseases such as diabetes22,23
and/or human immunodeficiency virus (HIV) co-
infection, which are best managed by integrated
health services.24–28 Continuity of care is essential for
patients with TB, who are often referred to multiple
services and facilities29 or, in some cases, transition
from prisons to the outside world,30,31 in their long
journey from diagnosis to cure. Further TB transmis-
sion may most effectively be prevented by broader
policies that address the communities and conditions
in which those affected live and work.30,32,33
These principles underpin the WHO’s End TB
strategy, which includes five key actions under
‘Integrated, patient-centred TB care and prevention’.
These are 1) prompt diagnosis, including drug
susceptibility testing and systematic screening of
contacts and high-risk groups, 2) treatment for TB
and multidrug-resistant TB (MDR-TB) and patient
support, 3) service integration with care for HIV and
other comorbidities, and 4) prevention.1 The strategy
describes patient-centred care as systematically as-
sessing and addressing the needs and expectations of
patients who should be provided with educational,
emotional and economic support based on their
needs. This strategy calls for 1) integrated services,
2) incorporation of social support into clinical care,
and 3) collaboration between all relevant stakehold-
ers, including the civil society and communities. The
‘Tuberculosis action plan for the WHO European
Region, 2016–2020’34 operationalises the WHO End
TB strategy in the European context, and comple-
ments a roadmap19 listing milestones, interventions
and activities to implement patient-centred care and
prevention, with the goal of eliminating TB and
MDR-TB in the WHO European Region. This has
since been operationalised in a detailed blueprint for
patient-centred TB care developed by a joint collab-
oration led by the WHO Regional Office.35
 Models of care for TB 135

DO EXISTING PEOPLE-CENTRED MODELS OF psycho-emotional support interventions were associ-

TUBERCULOSIS CARE AND PREVENTION ated with improved TB treatment outcomes.41 Other
WORK? systematic reviews have examined the treatment
setting, recognising the barriers that many patients
At one level, it may be argued that implementing
face in accessing health facilities. Thus, community-
people-centred TB care so that patients with TB and
based directly observed treatment (DOT), which is
their families are treated with dignity, compassion
closer to the patient, consistently achieves better
and respect, while considering their needs and
treatment outcomes than clinic-based DOT.13,42
preferences, is simply the right thing to do on moral
Those seeking insights into how to implement
grounds.12 But does people-centred care, as current-
patient- or people-centred care can now draw on a
ly implemented, actually work? Does it help to
growing body of evidence from resource-constrained,
detect TB cases as early as possible? Does it help to
high TB burden settings, including Burkina Faso,
ensure that patients diagnosed with TB receive
Ethiopia, urban Kenya, Tanzania, Malaysia, Central
adequate treatment? Does it increase adherence to
America, Nepal and Central Asia, among oth-
TB and MDR-TB treatment or prevent TB transmis-
ers.39,43–50 These report improved treatment success
sion?
compared with traditional facility-based manage-
A recent systematic review—which did not look
ment,43,46 better case detection43 and greater effec-
specifically at TB—found that most individual
tiveness of training in developing people-centred
interventions designed to enhance patient-centred
care.44 However, many of these studies have been
care focused on empowering patients, using educa-
small, with diverse study designs, and evaluated
tion or assistance to manage health consultations, or
heterogeneous interventions implemented at different
training providers in delivering empowering care.11 It
levels of care, or targeted different study populations
concluded that it was difficult to draw firm conclu-
in varied settings. Most have had a narrower focus on
sions due to the moderate-to-high risk of bias in
patient-centred care, although some have taken a
research design. Nevertheless, there were some
broader perspective, looking beyond the patient and
promising findings, most often in terms of patient
the health system. Thus, one study from Bangladesh
satisfaction and perceived quality of care. Measures
found higher rates of TB detection in children
that involved intervening directly with patients to
following the implementation of policies that reached
empower or inform them tended to be more effective
out to schools as well as community and religious
than those involving training health care providers.
leaders.51 However, as with many complex interven-
Many studies that have considered aspects of
tions, especially in low-resource settings, few have
patient-centred care in TB management have focused
provided quantitative data on effectiveness or cost-
on empowerment. Those studies have tended to
effectiveness or compared new models with other
concentrate on traditional interventions, especially
approaches to care, making it difficult to derive
education; systematic reviews have indicated that
robust conclusions.
education can improve adherence18,36 and reduce
treatment default in drug-resistant TB.37
Other studies have sought insights that enable THE WAY FORWARD
clinical management to be individualised. Interviews
There is strong political commitment to promote
with patients with MDR-TB in the Philippines have
people-centred care internationally, both in general
shown how many of the most important barriers to
and specifically in policies on TB. There is also a solid
adherence lay outside the health system, including the
rationale for adopting a people-centred approach to
need for assistance with transport, improvements to
TB care and prevention, recognising as morally
the current transportation assistance programme and
justified the provision of care that addresses the
food assistance, as well as difficulties related to
needs and expectations of the individual patient and
medications.38 A study from Nepal identified the
treats him/her with dignity. However, empirical
importance of tailored psychosocial support for
evidence on whether people-centred care actually
patients with MDR-TB.39 A study from Canada
improves outcomes is still limited, although now
implemented a system that explicitly included dignity
growing, especially from studies conducted in re-
in the clinical interaction to address issues related to
source-constrained settings.
respectfulness in patient-centred care.40 Over a third
We propose four areas where further action is
of health care providers reported learning new things
needed to ensure that people-centred TB care and
about their patients and having greater empathy with
prevention can achieve its full potential:
them.
Yet others have considered how to make TB  Research: there is a clear need to systematically
management more holistic, with a recent meta- review the evidence from studies of patient- and
analysis of data from randomised controlled trials, people-centred approaches to TB control, taking
cohort and case-control studies showing that certain into account diverse approaches. This could emu-
136 The International Journal of Tuberculosis and Lung Disease
late the approach taken in an earlier systematic
review of patient-centred care for chronic condi-
tions.11 Second, given the prominence of these
concepts in the End TB strategy, there is a need for a
targeted research programmes that can fill the gaps
that the systematic review reveals. These should
take full account of context, examining not only
what works but in what circumstances. This
approach, termed realist evaluation, considers the
many factors that influence the success or failure of
complex interventions,52 including existing capac-
ity in terms of physical infrastructure and human
resources, norms and values, and the policy
environment.
 Definitions and terminology: a conceptual frame-
work and set of definitions of patient- and people-
centred care specific to TB should be agreed upon
internationally. As noted above, this requires
consensus on what these terms really mean in all
settings where TB is managed.53 This should be
accompanied by further clarification of terminolo-
gy, including the abandonment of terms perceived
as judgmental and disempowering such as ‘TB
suspect’ and ‘treatment defaulter’, instead using
people-centred terms such as ‘people with presump-
tive TB’ and ‘person lost to follow-up’.53,54 The
WHO has already adopted more people-centred
terms.55
 Using and evaluating new technology: advances in
eHealth and mobile health may offer means to
support the implementation of patient-centred
care, ranging from timely sharing of medical
records to facilitate continuity of care and inte-
gration of services, to the use of ‘apps’ to promote
self-management.56 The potential of these ap-
proaches in bringing care closer to people remains
largely untapped in the case of TB, although
several small-scale studies suggest that web-based
recall-and-remind systems can improve adher-
ence.57
 Leadership, advocacy and partnerships: if patient-
or people-centred care of patients with TB is to
become a reality, there must be more leaders with
vision who can design models of care in settings that
are often complex and fragmented, and who can
implement them effectively. These leaders should
advocate the needs of patients with TB, many of
whom are drawn from the most marginalised and
stigmatised sections of society. On a positive note,
the Moscow Declaration to end Tuberculosis,
agreed to by 75 Ministers of Health in November
2017, include a reinforced commitment to promote
patient-centred care for TB.58,59 Leaders need to
work across sectors, mobilising support from a
diverse range of actors, including community and,
where appropriate, religious leaders, and create a
climate in which everyone, regardless of their social
circumstances or disease status, is valued. Collab-
oration and partnerships, both national and inter-
national, where partners can complement one
another and create ‘win-win’ synergies, are espe-
cially important given the existing resource con-
straints.
As one of the three strategic pillars identified in the
End TB strategy, ‘Integrated, patient-centred TB care
and prevention’ should be a guiding light for all those
involved in the quest to eliminate TB. It is intuitively
appealing and the principles underlying it have clear
moral and ethical bases. However, it should go
beyond the patient, recognising that people are
defined by more than their illness. The case for
implementing sustained models of people-centred
care that can reduce suffering and end TB by 2035
is clear, but there is still much to learn about how to
achieve this.
Conflicts of interest: none declared.
References
1 World Health Organization. Implementing the end TB strategy:
the essentials. WHO/HTM/TB/2015.31. Geneva, Switzerland:
WHO, 2015.
2 Marx F M, Atun R A, Jakubowiak W, McKee M, Coker R J.
Reform of tuberculosis control and DOTS within Russian
public health systems: an ecological study. Eur J Public Health
2007; 17: 98–103.
3 Yellapa V, Devadasan N, Krumeich A, et al. How patients
navigate the diagnostic ecosystem in a fragmented health
system: a qualitative study from India. Glob Health Action
2017; 10: 1350452.
4 Zelnick J R, O’Donnell M R, Ahuja S D, Chua A, Sullivan
Meissner J. Health care provider perspectives on tuberculosis
care for foreign-born populations in New York City. Int J
Tuberc Lung Dis 2016; 20: 1625–1632.
5 Bardes C L. Defining ‘patient-centered medicine’. N Engl J Med
2012; 366: 782–783.
6 Smith D M. Patient-centered teaching in medical and surgical
nursing. Am J Nurs 1950; 50: 314–315.
7 Balint E. The possibilities of patient-centered medicine. J R Coll
Gen Pract 1969; 17: 269–276.
8 Rogers C R. The characteristics of a helping relationship. In:
Rogers C R, ed. On becoming a person: a therapist’s view of
psychotherapy. Boston, MA, USA: Houghton Mifflin, 1961: pp
39–58.
9 Engel G L. The need for a new medical model: a challenge for
biomedicine. Science 1977; 196: 129–136.
10 Morgan S, Yoder L H. A concept analysis of person-centered
care. J Holist Nurs 2012; 30: 6–15.
11 McMillan S S, Kendall E, Sav A, et al. Patient-centered
approaches to health care: a systematic review of randomized
controlled trials. Med Care Res Rev 2013; 70: 567–596.
12 Epstein R M, Street R L, Jr. The values and value of patient-
centered care. Ann Fam Med 2011; 9: 100–103.
13 Wright C M, Westerkamp L, Korver S, Dobler C C.
Community-based directly observed therapy (DOT) versus
clinic DOT for tuberculosis: a systematic review and meta-
analysis of comparative effectiveness. BMC Infect Dis 2015; 15:
210.
14 Stewart M, Brown J B, Weston W W, McWhinney I R,
McWilliam C L, Freeman TR. Patient centred medicine
transforming the clinical method. Thousand Oaks, CA, USA:
Sage Publications, 1995.

15 World Health Organization Western Pacific Regional Office.
People-centred health care: a policy framework. Manila, The
Philippines: WPRO, 2007.
16 Goodwin N. Thinking differently about integration: people-
centred care and the role of local communities. Int J Integr Care
2014; 14: e026.
17 World Health Organization. Health systems strengthening
glossary. Geneva, Switzerland: WHO, 2017. http://www.who.
int/healthsystems/hss_glossary/en/index8.html#2 Accessed
October 2017.
18 Salleras Sanmarti L, Alcaide Megias J, Altet Gomez M N, et al.
Evaluation of the efficacy of health education on the
compliance with antituberculosis chemoprophylaxis in school
children. A randomized clinical trial. Tubercle Lung Dis 1993;
74: 28–31.
19 World Health Organization Regional Office for Europe.
Roadmap to implement the tuberculosis action plan for the
WHO European Region 2016–2020. Copenhagen, Denmark:
WHO, 2016.
20 Williams V. Universal patient-centred care: can we achieve it?
[Editorial] Int J Tuberc Lung Dis 2013; 17 (Suppl 1): 1–2.
21 de Vries S G, Cremers A L, Heuvelings C C, et al. Barriers and
facilitators to the uptake of tuberculosis diagnostic and
treatment services by hard-to-reach populations in countries
of low and medium tuberculosis incidence: a systematic review
of qualitative literature. Lancet Infect Dis 2017; 17: e128–e143.
22 Riza A L, Pearson F, Ugarte-Gil C, et al. Clinical management
of concurrent diabetes and tuberculosis and the implications for
patient services. Lancet Diabetes Endocrinol 2014; 2: 740–753.
23 Odone A, Houben R M, White R G, Lönnroth K. The effect of
diabetes and undernutrition trends on reaching 2035 global
tuberculosis targets. Lancet Diabetes Endocrinol 2014; 2: 754–
764.
24 Doherty A M, Kelly J, McDonald C, O’Dywer AM, Keane J,
Cooney J. A review of the interplay between tuberculosis and
mental health. Gen Hosp Psychiatry 2013; 35: 398–406.
25 Sinha S K, Saxena A, Mishra V, et al. Integration and
decentralisation of TB-HIV services increases HIV testing of TB
cases in Rajasthan, India. Public Health Action 2017; 7: 71–73.
26 Shenoi S V, Moll A P, Brooks R P, et al. Integrated tuberculosis/
human immunodeficiency virus community-based case finding
in rural South Africa: implications for tuberculosis control
efforts. Open Forum Infect Dis 2017; 4: ofx092.
27 Daftary A, Padayatchi N. Integrating patients’ perspectives into
integrated tuberculosis-human immunodeficiency virus health
care. Int J Tuberc Lung Dis 2013; 17: 546–551.
28 O’Donnell M R, Daftary A, Frick M, et al. Re-inventing
adherence: toward a patient-centered model of care for drug-
resistant tuberculosis and HIV. Int J Tuberc Lung Dis 2016; 20:
430–434.
29 Lin I P, Wu S C. Effects of long-term high continuity of care on
avoidable hospitalizations of chronic obstructive pulmonary
disease patients. Health Policy 2017; 121: 1001–1007.
30 Coker R, McKee M, Atun R, et al. Risk factors for pulmonary
tuberculosis in Russia: case-control study. BMJ 2006; 332: 85–
87.
31 Dara M, Acosta C D, Melchers N V, et al. Tuberculosis control
in prisons: current situation and research gaps. Int J Infect Dis
2015; 32: 111–117.
32 Reeves A, Basu S, McKee M, Stuckler D, Sandgren A, Semenza
J. Social protection and tuberculosis control in 21 European
countries, 1995–2012: a cross-national statistical modelling
analysis. Lancet Infect Dis 2014; 14: 1105–1112.
33 Stuckler D, Basu S, McKee M, Lurie M. Mining and risk of
tuberculosis in sub-Saharan Africa. Am J Public Health 2011;
101: 524–530.
34 World Health Organization Regional Office for Europe.
Tuberculosis action plan for the WHO European Region
Models of care for TB 137
2016–2020. EUR/RC65/17.Rev.1. Copenhagenn Denmark:
WHO, 2015.
35 World Health Organization. A people-centred model of TB
care. Geneva, Switzerland: WHO, 2017. http://www.euro.who.
int/__data/assets/pdf_file/0004/342373/TB_Content_WHO_
PRO_eng_final.pdf?ua¼1 Accessed October 2017.
36 Volmink J, Garner P. Systematic review of randomised
controlled trials of strategies to promote adherence to
tuberculosis treatment. BMJ 1997; 315: 1403–1406.
37 Toczek A, Cox H, du Cros P, Cooke G, Ford N. Strategies for
reducing treatment default in drug-resistant tuberculosis:
systematic review and meta-analysis. Int J Tuberc Lung Dis
2013; 17: 299–307.
38 Tupasi T, Garfin A M, Mangan J M, et al. Multidrug-resistant
tuberculosis patients’ views of interventions to reduce
treatment loss to follow-up. Int J Tuberc Lung Dis 2017; 21:
23–31.
39 Khanal S, Elsey H, King R, Baral S C, Bhatta B R, Newell J N.
Development of a patient-centred, psychosocial support
intervention for multi-drug-resistant tuberculosis (MDR-TB)
care in Nepal. PLOS ONE 2017; 12: e0167559.
40 Lopez C, Bertram-Farough A, Heywood D, et al. Knowing
about you: eliciting dimensions of personhood within
tuberculosis care. Int J Tuberc Lung Dis 2017; 21: 149–153.
41 van Hoorn R, Jaramillo E, Collins D, Gebhard A, van den Hof
S. The effects of psycho-emotional and socio-economic support
for tuberculosis patients on treatment adherence and treatment
outcomes—a systematic review and meta-analysis. PLOS ONE
2016; 11: e0154095.
42 Zhang H, Ehiri J, Yang H, Tang S, Li Y. Impact of community-
based DOT on tuberculosis treatment outcomes: a systematic
review and meta-analysis. PLOS ONE 2016; 11: e0147744.
43 Dembele S, Ouedraogo H, Macq J, Godin I, Kittel F, Dujardin
B. [A patient-centered approach to tuberculosis control in
Burkina Faso]. Santé 2008; 18: 135–140. [French]
44 Tadesse Y, Yesuf M, Williams V. Evaluating the output of
transformational patient-centred nurse training in Ethiopia. Int
J Tuberc Lung Dis 2013; 17 (Suppl 1): 9–14.
45 Njoroge A, Cassidy S, Williams V. Making patient-centred care
a reality in the slums of eastern Nairobi. Int J Tuberc Lung Dis
2013; 17 (Suppl 1): 5–8.
46 Egwaga S, Mkopi A, Range N, et al. Patient-centred
tuberculosis treatment delivery under programmatic
conditions in Tanzania: a cohort study. BMC Med 2009; 7: 80.
47 Mkopi A, Range N, Amuri M, et al. Health workers’
performance in the implementation of Patient Centred
Tuberculosis Treatment (PCT) strategy under programmatic
conditions in Tanzania: a cross sectional study. BMC Health
Serv Res 2013; 13: 101.
48 Atif M, Sulaiman S, Shafi A, Muttalif A, Ali I, Saleem F.
Applying patient centered approach in management of
pulmonary tuberculosis: a case report from Malaysia. J Basic
Clin Pharm 2011; 2: 129–131.
49 Macq J, Solis A, Martinez G, Martiny P. Tackling tuberculosis
patients’ internalized social stigma through patient centred
care: an intervention study in rural Nicaragua. BMC Public
Health 2008; 8: 154.
50 Khachadourian V, Truzyan N, Harutyunyan A, Thompson M
E, Harutyunyan T, Petrosyan V. People-centered tuberculosis
care versus standard directly observed therapy: study protocol
for a cluster randomized controlled trial. Trials 2015; 16: 281.
51 Islam Z, Sanin K I, Ahmed T. Improving case detection of
tuberculosis among children in Bangladesh: lessons learned
through an implementation research. BMC Public Health 2017;
17: 131.
52 Pawson R, Tilley N. Realistic evaluation. London, UK: Sage,
1997.
53 Zachariah R, Harries A D, Srinath S, et al. Language in
tuberculosis services: can we change to patient-centred
138 The International Journal of Tuberculosis and Lung Disease
terminology and stop the paradigm of blaming the patients? Int
J Tuberc Lung Dis 2012; 16: 714–717.
54 Biot M, Saranchuk P, Ellman T, Bygrave H, Bemelmans M.
Change to patient-centred terminology in tuberculosis: an
important step, but what about the treatment strategies? Int J
Tuberc Lung Dis 2012; 16: 1559–1560.
55 World Health Organization. Definitions and reporting
framework for tuberculosis—2013 revision. Updated
De cembe r 2014. WHO/HTM/TB/2013.2. Gene va,
Switzerland: WHO, 2014.
56 McDermott M S, While A E. Maximizing the healthcare
environment: a systematic review exploring the potential of
computer technology to promote self-management of chronic
illness in healthcare settings. Patient Educ Couns 2013; 92: 13–
22.
57 World Health Organization. Digital health in TB care and
control. Geneva, Switzerland: WHO, 2017. http://www.who.
int/tb/areas-of-work/digital-health/en/ Accessed October 2017.
58 World Health Organization. The Moscow Declaration to End
TB. Geneva, Switzerland: WHO, 2017. http://www.who.int/tb/
features_archive/Moscow_Declaration_to_End_TB_final_
ENGLISH.pdf Accessed November 2017.
59 Raviglione M, Uplekar M, Weil D, Kasaeva T. Tuberculosis
makes it onto the international political agenda for
health. . .finally. Lancet Glob Health 2018; 6: e20–e21.

CONTEXTE : Le premier pilier de la stratégie pour
mettre fin à la TB de l’Organisation Mondiale de la
Santé (OMS) est « Soins et prévention de la TB intégrés
et centrés sur le patient ». Mais que signifient des soins
centrés sur le patient et sur les personnes, et pourquoi
sont-ils importants en matière de soins et de prévention
de la tuberculose (TB) ?
O B J E C T I F E T J U S T I F I C A T I O N : Définir le concept de
soins centrés sur le patient, sa justification et son
évolution vers les soins centrés sur les personnes ;
explorer ensuite les éléments montrant si les approches
centrées sur les personnes fonctionnent pour la TB et les
domaines clés actuels dans lesquels des efforts continus
sont requis pour soutenir leur mise en œuvre.
R É S U LT A T S : En nous basant sur le raisonnement et les
M A R C O D E R E F E R E N C I A: El primer pilar de la
Estrategia para acabar con la Tuberculosis de la
Organización Mundial de la Salud consiste en ‘la
atención y la prevención de la tuberculosis, integradas
y centradas en el paciente’. Pero ¿en qué consiste una
atención centrada en las personas y en el paciente y por
qué son importantes en la atención y la prevención de la
tuberculosis (TB)?
O B J E T I V O Y F U N D A M E N T O: Definir el concepto de
atenci ón centrada en el paciente y exponer su
fundamento y su evoluci ón hacia una atenci ón
centrada en las personas; luego examinar la evidencia
sobre el desempeño de los enfoques centrados en las
personas en el caso de la TB y describir las principales
esferas en las cuales se precisan esfuerzos permanentes
que respalden su aplicación.
Models of care for TB i
R É S U M É
éléments présentés, nous proposons quatre domaines
dans lesquels davantage d’action est requise pour
s’assurer que les soins et la prévention de la TB centrés
sur les personnes puissent réaliser leur potentiel : 1)
aboutir à un consensus sur les définitions et la
terminologie ; 2) renforcer la recherche ; 3) utiliser et
évaluer les nouvelles techniques ; et 4) renforcer le
leadership et le plaidoyer dans le pays.
C O N C L U S I O N : Les soins et la prévention de la TB
intégrés, centrés sur les personnes, devraient être la
lumière qui guide tous ceux qui sont impliqués dans la
quête visant à éliminer la TB, mais il reste beaucoup à
faire pour combler le fossé entre performance potentielle
et réelle des programmes nationaux.
RESUMEN
R E S U LT A D O S: A partir de los argumentos y la evidencia
presentados, se proponen cuatro campos en los cuales es
necesario introducir nuevas medidas, de manera que la
prevención y la atención de la TB centradas en las
personas alcancen todo su potencial, a saber: 1) lograr la
unanimidad en torno a las definiciones y la terminologı́a;
2) fortalecer la investigación; 3) utilizar las nuevas
tecnologı́as y evaluarlas; y 4) fomentar el liderazgo y la
promoción de la causa en el paı́s.
C O N C L U S I Ó N: La atención y la prevención de la TB,
integradas y centradas en las personas, deben guiar el
camino de todas las personas que participan en la
cruzada de la eliminación de la TB, pero aun queda
mucho por hacer para salvar la distancia entre el
desempeño óptimo y el desempeño actual de los
programas nacionales.