Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

Ritchie, Lisa M Puchalski; Lettow, Monique van; Makwakwa, Austine; Kip, Ester C.; Straus, Sharon E.; Kawonga, Harry; Hamid, Jemila S.; Lebovic, Gerald; Thorpe, Kevin E.; Zwarenstein, Merrick; Schull, Michael J.; Chan, Adrienne K.; Martiniuk, Alexandra; Schoor, Vanessa van

doi:10.1186/s13012-020-01067-y

Cited by 7 publications

(6 citation statements)

References 23 publications

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“…Our study revealed challenges in the lack of trained community health workers, which negatively influenced program implementation. These findings are consistent with a multi-country study in Afghanistan, Democratic Republic of Congo, Haiti, Somalia [ 27 ], and other studies in Malawi [ 28 ] and Tanzania [ 29 ] revealing hampered DOTS services expansion due to the limited capacity of trained staff, thus contributing to the high proportion of missing TB outcomes. Furthermore, the lack of adequately trained and qualified staff has been identified globally as a major factor preventing the successful achievement of TB targets.…”

Section: Discussionsupporting

confidence: 91%

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana

Sejie

Mahomed

2023

PLoS ONE

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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.

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Section: Discussionsupporting

confidence: 91%

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana

Sejie

Mahomed

2023

PLoS ONE

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“…19 Effectiveness of the intervention in improving TB treatment success rates was assessed within the context of a pragmatic cluster randomised trial in four districts in the south east zone of Malawi, with 51 HCs randomised to the intervention arm and is reported in detail elsewhere. 20 The process evaluation employed a mixed-methods design informed by the Reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework, 21 22 and our experience with the pilot study. In keeping with our pragmatic design, data sources for the process evaluation were selected to limit contact with participants in order to reduce the potential for process evaluation data collection to act as a booster to implementation.…”

Section: Methodsmentioning

confidence: 99%

“…There was no significant effect of the intervention on TB treatment success, adjusted OR 1.35 (95% CI 0.93 to 1.98), with high variation in implementation quality a potential contributing factor. 20 LHW interview participants and quarterly PT meeting notes, revealed a variety of benefits of the intervention to LHWs including: increased knowledge, improved skills in patient-provider interactions and counselling, better collaboration among providers, and improved patient care. While some PTs reported use of the phone stipend to discuss challenges or problem solve with their peers during initial cascade training and reported this support as essential to their success, few reported continued use of the peer support network beyond the first quarter of 'Since I started receiving medication here I have never faced any insult, they welcome me well and they also make sure that I am taking my drugs accordingly'…”

Section: Effectivenessmentioning

confidence: 99%

“…16 17 Given these findings and stakeholder interest in exploring potential scale-up, we refined the intervention and implementation strategy based on feedback and our implementation experience in the pilot study and evaluated the refined intervention using a mixed-methods design. Effectiveness of the intervention in improving TB treatment completion rates was evaluated in a cluster randomised controlled trial, reported in detail elsewhere, 20 with findings of the process evaluation reported here.…”

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confidence: 99%

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Process evaluation of an implementation strategy to support uptake of a tuberculosis treatment adherence intervention to improve TB care and outcomes in Malawi

et al. 2021

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ObjectiveTo assess implementation and to identify barriers and facilitators to implementation, sustainability and scalability of an implementation strategy to provide lay health workers (LHWs) with the knowledge, skills and tools needed to implement an intervention to support patient tuberculosis (TB) treatment adherence.DesignMixed-methods design including a cluster randomised controlled trial and process evaluation informed by the RE-AIM framework.SettingForty-five health centres (HCs) in four districts in the south east zone of Malawi, who had an opportunity to receive cascade training.ParticipantsForty-five peer-trainers (PTs), 23 patients and 20 LHWs.InterventionImplementation strategy employing peer-led educational outreach, a clinical support tool and peer support network to implement a TB treatment adherence intervention.Outcome measuresProcess data were collected from study initiation to the end-of-study PT meeting, and included: LHW and patient interviews, quarterly PT meeting notes, training logs and study team observations and meeting notes. Data sources were first analysed in isolation, followed by method, data source and analyst triangulation. Analyses were conducted independently by two study team members, and themes revised through discussion and involvement of additional study team members as needed.ResultsForty-one HCs (91%) trained at least one LHW. Of 256 LHWs eligible to participate at study start 152 (59%) completed training, with the proportion trained per HC ranging from 0% to 100% at the end of initial cascade training. Lack of training incentives was the primary barrier to implementation, with intrinsic motivation to improve knowledge and skills, and to improve patient care and outcomes the primary facilitators of participation.ConclusionWe identified important challenges to and potential facilitators of implementation, scalability and sustainability, of the TB treatment adherence intervention. Findings provide guidance to scale-up, and use of the implementation strategies employed, to address LHW training and supervision in other areas.Trial registration numberNCT02533089.

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“… 74–77 One study described an intervention that aimed to improve the knowledge and skills of lay health workers to improve TB care provided to patients and subsequently improve treatment adherence. 78 …”

Section: Resultsmentioning

confidence: 99%

Evaluations of training and education interventions for improved infectious disease management in low-income and middle-income countries: a systematic literature review

et al. 2022

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ObjectivesTo identify most vital input and outcome parameters required for evaluations of training and education interventions aimed at addressing infectious diseases in low-income and middle-income countries.DesignSystematic review.Data sourcesPubMed/Medline, Web of Science and Scopus were searched for eligible studies between January 2000 and November 2021.Study selectionHealth economic and health-outcome studies on infectious diseases covering an education or training intervention in low-income and middle-income countries were included.ResultsA total of 59 eligible studies covering training or education interventions for infectious diseases were found; infectious diseases were categorised as acute febrile infections (AFI), non-AFI and other non-acute infections. With regard to input parameters, the costs (direct and indirect) were most often reported. As outcome parameters, five categories were most often reported including final health outcomes, intermediate health outcomes, cost outcomes, prescription outcomes and health economic outcomes. Studies showed a wide range of per category variables included and a general lack of uniformity across studies.ConclusionsFurther standardisation is needed on the relevant input and outcome parameters in this field. A more standardised approach would improve generalisability and comparability of results and allow policy-makers to make better informed decisions on the most effective and cost-effective interventions.

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Impact of a tuberculosis treatment adherence intervention versus usual care on treatment completion rates: results of a pragmatic cluster randomized controlled trial

Cited by 7 publications

References 23 publications

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana

Process evaluation of an implementation strategy to support uptake of a tuberculosis treatment adherence intervention to improve TB care and outcomes in Malawi

Evaluations of training and education interventions for improved infectious disease management in low-income and middle-income countries: a systematic literature review

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