Community-involved strategy to improve tuberculosis (TB) treatment outcomes in Eastern Region of Ghana
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Introduction: One of the challenges facing the health systems is to bring the provision of health services as close as possible to those who need them. The need to promote community contribution to TB care as part of National Tuberculosis Programme (NTP) activities is particularly urgent in Sub-Sahara Africa, where the human immunodeficiency virus (HIV) is fuelling the TB epidemic. With the necessary support, communities have the potential to contribute to TB care.Objectives: To evaluate decentralization and community supervision of Tuberculosis treatment as an effective intervention to improve treatment outcomes in Eastern Region of GhanaMethods/ Design: A historical comparison of treatment outcomes of cohorts registered in 2003-2005 with centralized Directly Observed Treatment short course (DOTs) at health facility level and cohorts registered in 2007-2009 with decentralized DOTs at the community level. Effectiveness was measured by comparing TB case finding and treatment outcomes before and after the introduction of the decentralization with the active participation of local communities providing the option of treatment supervision. Result: In total 5128 cases were registered during the centralized period with 60% being men and 40% women. In the decentralized period 5309 cases were recorded with 62.7% men and 37.3% women. Among new smear-positive pulmonary TB cases there was a significant difference between treatment success rates in the decentralised period as compared to the centralized period (82.7% vs 69.6% respectively; p-value < 0.0001). Cured rate improved during the decentralized period as against the centralized period (75.8% vs 63.2% respectively; p-value < 0.0001). Defaulter rate significantly reduced in the decentralized period as compared to the centralized period (3.6% vs 12.1% respectively; p-value < 0.0001). Among new sputum smear-negative and extra pulmonary TB patients, treatment completion rate was significantly higher in the decentralized period than in the centralized (80.2% vs 56.3% respectively; p-value < 0.0001) and defaulter rate was significantly reduced in the decentralized period than in the centralized period (3.3% vs 17.7% respectively; p-value < 0.0001). Conclusion and Reccomendations: Decentralization of TB treatment to the community level, empowering TB patients to choose treatment supporters from the community and communities providing treatment supervision till cure, improved treatment outcomes in Eastern Region of Ghana.
- 2012-10-00