Experiences of a community-based tuberculosis treatment programme in Namibia: a comparative cohort study

Abstract

Background: Tuberculosis (TB) remains a widespread healthcare problem in Africa, although it can be cured within 6-8 months' effective treatment. However, many patients fail to adhere to TB treatment, resulting in failure to get cured and the possible development of multi-drug resistant TB (MDR TB). A community-based TB treatment programme, was started in the Omaheke region of Namibia during 2002. The efficacy of this community-based TB programme, compared to the standard hospital- and clinic-based TB treatment, was unknown.

Objectives: The major objectives were to compare TB treatment outcomes for patients who used the community-based TB with those who chose the clinic/self-administered TB treatment option; and to identify advantages and disadvantages of community-based TB care as experienced by patients who had completed their community-based TB treatment.

Design: A quasi-experimental study design was used to compare TB patients' treatment outcomes using checklists and exit interviews.

Setting: The study was conducted in the Omaheke region of Namibia.

Participants: TB patients (n=332) who were hospitalised during the study period participated in the study.

Methods: An analytic cohort prospective design was used to do follow-up visits, and complete checklists, of 332 TB patients. Structured exit interviews were conducted with 101 TB patients who had completed their community-based TB treatment.

Results: Enhanced knowledge of TB patients improved their participation in community-based TB care. A family member was the most convenient, acceptable and accessible directly observed treatment (DOT) supervisor for 72.8% of the participants. A statistically significant difference in cure rates between community-based and the clinic/self-administered groups was found (chi(2) 11.78; p<or=0.05; and RR=1.35; p=0.05). The major advantages of community-based TB treatment included the ability to continue with one's daily activities during treatment and the saving of time and money. The major disadvantages included that the clinics ran out of TB drug supplies, patients did not always have food to eat after taking their pills and they could not get sufficient rest because they had to continue doing their daily chores.

Conclusions: TB patients on the community-based TB treatment option had better cure rates than those on clinic/self-administered TB treatment (although it cannot be inferred that the community-based treatment caused the improved cure rates, because the TB patients who did not select the community-based treatment option might have been different). The advantages experienced by patients who completed their community-based TB treatment outweighed the disadvantages.