Patient-centred tuberculosis treatment delivery under programmatic conditions in Tanzania: a cohort study

Abstract

BackgroundDirectly observed therapy (DOT) remains the cornerstone of the global tuberculosis (TB) control strategy. Tanzania, one of the 22 high-burden countries regarding TB, changed the first-line treatment regimen to contain rifampicin-containing fixed-dose combination for the full 6 months of treatment. As daily health facility-based DOT for this long period is not feasible for the patient, nor for the health system, Tanzania introduced patient centred treatment (PCT). PCT allows patients to choose for daily DOT at a health facility or at their home by a supporter of choice. The introduction of fixed dose combinations in the intensive and continuation phase made PCT feasible by eliminating the risk of selective drug taking by patients and reducing the number of tablets to be taken. The approach was tested in three districts with the objective to assess the effect of this strategy on TB treatment outcomesMethodsCohort analysis comparing patients treated under the PCT strategy (registered April-September 2006) with patients treated under health-facility-based DOT (registered April-September 2005). The primary outcome was the cure rate. Differences were assessed by calculating the risk ratios. Associations between characteristics of the supporters and treatment outcomes in the group of patients opting for home-based DOT were assessed through logistic regression.ResultsIn the PCT cohort there were 1208 patients and 1417 were included in the historic cohort. There was no significant difference in cure rates between the cohorts (risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.96-1.16). In the PCT cohort, significantly more patients had successful treatment (cure or treatment completed; RR: 1.10; 95%CI: 1.01-1.15). There were no characteristics of supporters that were associated with treatment outcome.ConclusionThe PCT approach showed similar cure rates and better treatment success rates compared to daily health-facility DOT. The results indicate that there are no specific prerequisites for the supporter chosen by the patient. The programmatic setting of the study lends strong support for scaling-up of TB treatment observation outside the health facility.

It’s complicated: why do tuberculosis patients not initiate or stay adherent to treatment? A qualitative study from South Africa

“…A larger community based or mobile service should be a high priority, for instance in Cambodia where patients who were severely ill or faced challenges regarding transport noted that home-based care was an acceptable alternative [8], similar to what was found in Swaziland [28] and in Uganda [29], where TB patients indicated that community-based care was preferred to hospital or clinic-based care. In Tanzania, it was also shown that a patient-centred treatment approach had better treatment success rates compared to daily health facility DOTS [30] and that treatment supporters who live close to the patient facilitate adherence [31]. …”

Adherence to Tuberculosis Therapy among Patients Receiving Home-Based Directly Observed Treatment: Evidence from the United Republic of Tanzania

“…We compared a postulated estimate for adherence in the intensive phase (85%) with a hypothesized value of adherence in the conventional DOT strategy in Tanzania (75%). The hypothesized population value was based on the conversion rate seen in the control cohort (health facility-based DOT) of the PCT pilot study [4]. The study hypothesis was that the postulated value would not be lower than the hypothesized value, that is, the lower limit of the confidence interval around (CI) the estimate of adherence should be above 75%.…”

“…This approach offers new TB patients the choice between home-based treatment (HB-DOT) supervised by a treatment supporter of their own choice, and health facility-based treatment (HF-DOT) observed by a medical professional. The PCT approach was tested for effectiveness in three pilot districts and showed a positive effect on treatment outcome for TB patients [4]. It was adopted as national policy in 2006 and scaled up to the rest of the country.…”

Current Knowledge and Future Research on Infant Feeding in the Context of HIV: Basic, Clinical, Behavioral, and Programmatic Perspectives

“…Infant feeding and HIV 235 patient satisfaction and adherence in HIV and TB treatment programs (167)(168)(169). Unfortunately, the role of counseling has sometimes been overlooked as a strategy for PMTCT (170) and as such, far less research has been done evaluating its effectiveness in terms of health outcomes or cost than has gone into biomedical interventions.…”