Effectiveness of home-based directly observed treatment for tuberculosis in Kweneng West subdistrict, Botswana.
Thesis (MFamMed)--Stellenbosch University, 2015.
ENGLISH: ABSTRACT: Introduction: Tuberculosis and HIV are major public health problems in Botswana. The Botswana National Tuberculosis Control Programme (BNTP) was established in 1975. Short course chemotherapy was introduced in 1986 and the Directly Observed Treatment (DOT) Strategy was adopted in 1993. In the face of growing TB notification rates, a low country average cure rate, human resource constraints in health facilities and sometimes poor accessibility to health facilities by weak patients and those living far away, Botswana decided to offer home-based care using volunteers or family members. Setting: Kweneng West Subdistrict, a rural area in Botswana Aim and objectives: The aim of this study was to assess the success of home-based DOT in the management of tuberculosis compared to facility-based DOT in Kweneng West Subdistrict, Botswana and to explore the acceptability of home-based DOT among TB patients, TB treatment supervisors and health workers. Objectives: - To compare treatment outcomes for patients receiving home-based DOT and those receiving facility-based DOT through the following criteria: - To compare patient contact(s) tracing efforts among home-based providers and facility-based providers - To establish TB patient’s, TB treatment supervisor’s and health worker’s perceptions about home-based DOT Methods: A quantitative, observational study combined with qualitative in-depth interviews. Participants were selected from TB patients who attended treatment from January 2006 till June 2008 at all main clinics of Kweneng West Subdistrict, Botswana. The interview purposively selected health care workers, TB patients and community supervisors to establish their thoughts about HB DOT. A framework approach was used to analyse interviews. Results: Treatment outcomes and, particularly, the cure rates were not statistically different between FB DOT, HB DOT and MX DOT. However there was a surprisingly difference in contact tracing, with FB DOT performing better than other DOT types. Interviews revealed that patients were happy with their choice of DOT types. Among reasons to choose HB DOT was the need to shorten distances for DOT. Among reasons to choose FB DOT were the needs to ensure safety through supervision by nurses as opposed to lay people (community supervisors) and to obtain injections that no community supervisor is allowed to administer. A mix of HB DOT and FB DOT was generally adopted to allow flexibility in the administration of DOT for few patients. Overall cure rate was 78.5% and successful treatment rate was 83%. Conclusion: The introduction of HB DOT and the option given to choose this DOT type is supported. Indeed allowing patient’s preference of DOT type may impact positively on patients’ satisfaction and adherence to medication. On the other hand, issues were still raised by all stakeholders to help improve the flexibility and sustainability of HB DOT. Further studies may be needed to understand the better performance of FB DOT in contact tracing.
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