Background Tuberculosis is a significant global public health threat, especially in countries with limited resources. To improve tuberculosis care, the World Health Organization emphasizes the importance of considering a TB patient’s journey across a variety of connected settings and facilities. A systematic review was conducted to map previously conducted studies to identify existing community TB implementation models, their effectiveness on cost, and treatment outcomes. Methods Systematic search through various electronic databases MEDLINE, EBSCO (PsycINFO and CINAHL), Cochrane Library, EMBASE, WHO Regional Databases, gray literature, and hand-searched bibliographies was performed. Articles published in English between the years 2000 and 2022 with a substantial focus on community TB implementation models were considered for inclusion. Studies were excluded if the intervention was purely facility-based and those focusing exclusively on qualitative assessments. Two reviewers used standardized methods to screen titles, abstracts, and data charting. Included studies were assessed for quality using ROBINS-I and ROB 2. Analysis of study results uses a PRISMA flow diagram and quantitative approach. Results A total of 6982 articles were identified with 36 meeting the eligibility criteria for analysis. Electronic medication monitors showed an increased probability of treatment success rate (RR 1.0–4.33 and the 95% CI 0.98–95.4) in four cohort studies in low- and middle-income countries with the incremental cost-effectiveness of $434. Four cohort studies evaluating community health worker direct observation therapy in low- and middle-income countries showed a treatment success risk ratio of up to 3.09 with a 95% CI of 0.06–7.88. (32,41,43,48) and incremental cost-effectiveness up to USS$410. Moreover, four comparative studies in low- and middle-income countries showed family directly observed treatment success risk ratio up to 9.07, 95% CI of 0.92–89.9. Furthermore, four short message service trials revealed a treatment success risk ratio ranging from 1.0 to 1.45 (95% CI fell within these values) with a cost-effectiveness of up to 350I$ compared to standard of care. Conclusions This review illustrates that community-based TB interventions such as electronic medication monitors, community health worker direct observation therapy, family directly observed treatment, and short message service can substantially bolster efficiency and convenience for patients and providers while reducing health system costs and improving clinical outcomes.

Background Tuberculosis (TB) is a major public health problem throughout the world particularly in resource limited countries. In light of the global urgency to improve TB care, the World Health Organisation emphasize the importance of taking into consideration the journey of a TB patient through a series of interlinked settings and facilities. One of these is decentralising TB care beyond health facilities and harness the contribution of communities through provision of effective community-based directly observed therapy (DOT) to TB patients at greatest socio-economic risk. A systematic review was conducted to map previously conducted studies to identify existing community TB implementation models, their effectiveness on cost and treatment outcomes. Methods Systematic search through various electronic databases electronic databases; Medline/PubMed, EBSCO (PsycINFO and CINAHL) and Cochrane libraries was performed between the year 2000 and 2021. We used the following free text search terms Tuberculosis, Community tuberculosis, cost effectiveness and treatment outcomes for this purpose. Their quality was scored by ROBINS-I and ROB 2. Results A total of 6982 articles were identified with 36 meeting the eligibility criteria for analysis. Two observational studies in low- and middle-income countries reported comparable video observed t reatment completion rates to in-person directly observed therapy (0.99-1.47(95% CI 0.93-2,25) with one randomised control trial in a high-income country reporting an increased video observed treatment success rate to standard care (OR 2.52, 95% CI 1.17-5.47). An incremental cost saving ranged was $1391-$2226. Electronic medication monitors increased the probability of treatment success rate (RR 1.0-4.33 and the 95% CI 0.98-95.4) in four cohort studies in low- and middle-income countries with incremental cost effectiveness of $434. Four cohort studies evaluating community health worker direct observation therapy in low- and middle-income countries showed treatment success risk ratio ranging between 0.29-3.09 with 95% CI 0.06-7.88. (32,41,43,48) with incremental cost effectiveness up to USS$410 while four randomised control trials in low- and middle-income countries reported family directly observed treatment success odds ratios ranging 1.03- 1.10 95% CI 0.41-1.72. Moreover, four comparative studies in low- and middle-income countries showed family directly observed treatment success risk ratio ranging 0.94- 9.07 ,95% CI 0.92- 89.9. Lastly four Short Message Service trials revealed a treatment success risk ratio ranging 1.0–1.45, 95% CI fell within these values) with cost effectiveness of up to 350I$ compared to standard of care.   Conclusions This review illustrates that community-based TB interventions such as video observed therapy, electronic medication monitors, community health worker direct observation therapy, family directly observed treatment and short Message Service can substantially bolster efficiency and convenience for patients and providers thus saving costs and improving clinical outcomes.

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Background Eliminating Tuberculosis is one of the targets of Sustainable Development Goal Three. Decentralizing TB care beyond health facilities by leveraging community involvement is crucial for safeguarding effective tuberculosis care. In this study, we explored potential facilitators and inhibitors of the implementation and sustainability of community-based interventions for the prevention and treatment of TB in the Moshupa district, Botswana. Methods This study adopted a qualitative approach using a collective case design. An interpretive paradigm based on relativist ontology and subjectivist epistemology along with abductive research logic was used. The study enrolled treatment supporters of tuberculosis patients diagnosed with drug-susceptible tuberculosis between January 2019 and December 2019 in Moshupa Village for semi-structured interviews, Health care professionals for in-depth interviews, and e community leaders for focus group discussions. Clinic-based observations in Mma-Seetsele clinic were also conducted to corroborate the participants’ views. The data collected was analyzed using the NVivo version 12 software package, and statements of the participants were presented as quotes to substantiate the issues discussed. Results This study highlighted effective partnerships between health services and external stakeholders, community empowerment, and the availability of policies and standard operating procedures as facilitators of community TB implementation and sustainability. However, Insufficient funding, low service provider training, policies not embracing age and educational eligibility for treatment supporters, shortage of equipment, medicines, and supplies, inadequate transport availability and incentives to meet clients’ basic needs, paper-based systems, inadequate supervision, incomplete data reporting, and low service quality affected the Community TB program efficacy and sustainability in Moshupa. We also found that there was low service provider motivation and retention and that clients had low trust in treatment supporters. Conclusion The findings of this study imply that the operational effectiveness of the community TB care approach to disease elimination is compromised; therefore, initiatives addressing the key components, including the availability of resources, governance arrangements and supportive systems for community health workers, are required for successful community TB implementation and sustainability.