Impact of mobile teams on tuberculosis treatment outcomes, Riyadh Region, Kingdom of Saudi Arabia, 2013–2015

Abstract

The objective of this study was to evaluate the impact of the tuberculosis (TB) mobile teams on treatment outcomes in Riyadh Region by comparing patients who received treatment under mobile teams and those who did not, from 2013 to 2015. This was a retrospective descriptive study using National TB Control and Prevention Program data from 2013 to 2015 from Riyadh, Kingdom of Saudi Arabia. Descriptive analyses were used to summarize characteristics of TB case-patients served by mobile teams and those who were not served. The χ test measured the significant differences between mobile-served and non-mobile-served case-patients. Exposure was whether or not the TB case-patient was under the care of the mobile team; the outcome of interest was whether or not treatment was successful, defined as treatment completed and cured. We found that the ratio of treatment success among mobile team case-patients was 1.28 greater than among those not served by mobile teams. The χ test showed a statistically significant finding (probability ratio=1.28; 95% confidence interval=1.21-1.35, p<0.01). Mobile teams increased the treatment success rate to 92%, compared to 71.77% among those not served by mobile teams. This study shows that community mobilization of mobile teams is an effective strategy to enhance TB treatment, reduced mortality and loss to follow-up and improve TB treatment outcomes.

High non-compliance rate with anti-tuberculosis treatment: a need to shift facility-based directly observed therapy short course (DOTS) to community mobile outreach team supervision in Saudi Arabia

“…More than 90% of these deaths are reported from low- and middle-income countries, and this figure is probably still an underestimate of the actual numbers of fatalities caused by the disease [3, 4]. Under-reporting of actual numbers of cases, and the issue of undiagnosed cases are most probably the major reasons behind this suspected miscalculation [4, 5].…”

“…Successful TB management requires the administration of anti-TB drugs for at least 6 months [6]. The long duration of the treatment, which needs to continue even after apparent clinical recovery, is one of the main reasons for patient non-completion of their courses of treatment [5–7]. Among other explanations for patients’ non-completion of recommended treatment are the fear of side effects, social stigmatization, illiteracy and inadequate knowledge on the part of patients and their families about the possible serious outcomes of the disease (like relapse, drug resistance, prolonged hospitalization or even death) [8–11].…”

“…Several recent reports have highlighted the worldwide reemergence of TB, and more specifically its effect in developing countries, of which Saudi Arabia is one [12]. In order to address the issue of patient non-compliance with treatment, the WHO launched a ‘Directly Observed Treatment Short Course (DOTS)’ strategy in 1993 [5, 13]. In accordance with this strategy, a treatment observer whose key task is to ensure that the patient is taking their medicine, is assigned to each patient.…”

“…In our study, the DOTS close supervision of patients to make sure they took their medicines, was applied both in the facility-based treatment regime and the mobile outreach program. In practice, these DOTS therapeutic regimens have proved to be highly effective in reducing the treatment failure rate associated with patient non-compliance [4, 5].…”

“…In 1999 the WHO DOTS strategy was formally adopted [16, 18]. The literature shows that even after three decades of the NTCPP and DOTS programs, TB treatment coverage is only around 87% of patients, and the treatment success rate is only 62% [5, 18, 20]. These figures are far lower than the WHO targets of 85% treatment success rates [3, 21].…”