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

Author:

Egwaga Saidi,Mkopi Abdallah,Range Nyagosya,Haag-Arbenz Vera,Baraka Amuri,Grewal Penny,Cobelens Frank,Mshinda Hassan,Lwilla Fred,van Leth Frank

Abstract

Abstract Background Directly 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 outcomes Methods Cohort 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. Results In 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. Conclusion The 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.

Publisher

Springer Science and Business Media LLC

Subject

General Medicine

Reference28 articles.

1. World Health Organization: Global Tuberculosis Control: Surveillance, Planning, Financing. 2008, Geneva: WHO

2. Cobelens FG, Egwaga SM, van Ginkel T, Muwinge H, Matee MI, Borgdorff MW: Tuberculin skin testing in patients with HIV infection: limited benefit of reduced cutoff values. Clin Infect Dis. 2006, 43 (5): 634-639. 10.1086/506432.

3. World Health Organization: Treatment of Tuberculosis: Guidelines for National Programmes. 2003, Geneva: WHO, 3

4. Enarson DA, Rieder HL, Arnadottir T, Trébucq A: Management of Tuberculosis: A Guide for Low Income Countries. 2000, Paris: International Union Against Tuberculosis and Lung Disease, 5

5. World Health Organization: Anti-tuberculosis Drug Resistance in the World: Fourth Global Report. 2008, Geneva: WHO

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