Tuberculosis in the community: 1. Evaluation of a volunteer health worker programme to enhance adherence to anti-tuberculosis treatment

Abstract

Setting: A voluntary health worker project (Operation Elsies River) was started in a high incidence tuberculosis (TB) area in the Western Cape of South Africa, in order to assist the local TB Control programme with case-holding.

Objective: To evaluate the effectiveness of this group of volunteers in enhancing adherence of notified TB patients to tuberculosis treatment.

Design: A cohort study was conducted with 351 TB patients (203 children and 148 adults).

Results: The data from the child and the adult groups were analysed separately. The child group was more adherent to TB treatment than adults. The supervision option with staff dedicated to the treatment of TB, such as the clinic and the SANTA crèche, achieved better adherence results for pre-school children. The supervision modalities for adults did not differ in their adherence performance even following adjustment for confounders.

Conclusion: The supervision option provided by the volunteers did not significantly improve the adherence of adult patients to antituberculosis treatment.

PIP: A cohort study conducted in South Africa's Western Cape region found that the use of voluntary health workers as supervisors of tuberculosis treatment did not significantly improve treatment adherence among adult patients. The Western Cape Region, representing 9% of South Africa's population, accounts for 28% of tuberculosis cases. The tendency of tuberculosis patients to discontinue their medication once clinical symptoms of disease abate constitutes a primary obstacle to tuberculosis control. The Operation Elsies River Project recruited and trained 88 community volunteers, primarily married women who had suffered from tuberculosis or experienced the disease in their family, to administer tablets and observe that they were swallowed. In a 6-month period in 1992, there were 351 ambulatory patients (203 children under 15 years old and 148 adults) with primary or pulmonary tuberculosis in the Elsies River region. The volunteer group supervised the treatment regimen of 82 (23%) of these patients. Supervision of the remaining patients was provided by the primary health care center nurse (175 patients) or designated persons at workplaces, schools, or nurseries. Adherence was defined as the patient taking 75% or more of the prescribed medication during the first 6 months of treatment. The overall mean adherence rate for all types of supervision was 68% (73% among children and 62% among adults). Among children, the supervision provided by volunteers or at a nursery achieved higher adherence results than the health center. Among adults, however, no one supervision option performed significantly better than any other.