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

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
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.