A retrospective cohort study : the directly observed treatment short-course strategy (dots) and tuberculosis treatment outcomes at Vryheid during 2007 : facilty versus community based dots

Kikamba, C. N. (2009-12)

Thesis (MFamMed)--Stellenbosch University, 2015.

Thesis

ENGLISH ABSTRACT: 1. BACKGROUND AND SETTING The study was conducted at Vryheid in the Kwazulu-Natal province. The increasing number of TB patients at Vryheid hospital’s OPD and wards has prompted me to assess the effectiveness of TB treatment by comparing the treatment outcomes between community-based DOTS (COMDOTS) and facility-based DOTS (FACDOTS). 2 main primary health care clinics were selected for the research (Bhekuzulu and Mason clinics). 2. AIM This thesis evaluated the effectiveness and efficacy of DOTS strategy by comparing the outcomes of tuberculosis treatment of patients under DOTS at VRYHEID during 2007: facility based versus community based DOTS. 3. METHODS The research question of the study was “Does community-based DOTS offer better TB treatment outcomes than the facility-based group? This is a retrospective cohort study with a total sample size of 809 patients; retrieved from the records of 2 major clinics at Vryheid (TB registers) during 2007. A sample of 396 patients was required in each group to determine a difference of 10 % (with a power of 90%) between the two groups of the study: community-based versus facility-based. Mason clinic has mostly patients on facility-based DOTS whereas the patients involved in community-based approach were found at Bhekuzulu clinic. 4. RESULTS The 2 groups of the study (COMDOTS and FACDOTS) were comparable in terms of age and gender composition. 52% of patients in the community-based group completed their TB treatment and only 37.7% in the facility-based group. 14% of patients died in the community-based DOTS group versus 6.1% in the facility-based group. 4.5% of community-based group defaulted medications, as compared to 1.7% in the facility-based group. 34.8% of facility-based DOTS interrupted treatment whereas the percentage is lower in the community-based group (1%). The community-based group had a failure rate of 6% versus 3.7% in the facility-based. The majority of patients in both groups were diagnosed on the basis of X-rays (82% in the community- and 57.1% in the facility-based group). Patients for whom an HIV test result was available were extremely likely to be HIV positive in both groups (80% in the facility-based and 84.6% in the community-based group), however the number of available test results was low. Amongst the sputum-positive patients, the community-based group was shown to have a cure rate of 95 percent (versus 37.1% in the facility-based group). Patients in the community-based group remained longer on TB treatment than the ones in the facility-based group (5.7 vs 5.0 months). However, the community-based group had a higher percentage of retreatment cases (22.4% versus only 12.7% in the facility-based group). 5. CONCLUSION: This study suggests that community-based DOTS offers a better cure rate (95%) and completion of therapy (52%). The longer duration of treatment observed in the community-based group could be partly due to its relatively higher number of retreatment cases as compared to facility-based group. An extremely high HIV rate (> 80%) has also been found in the TB-patient population in both groups. Community-based DOTS offers an alternative way for patients who do not have easy access to the clinics, provided the government strengthens the system and takes over recruitment as well as monitoring and motivation (incentives) of community-health workers. There is also a growing concern with the relatively high number of patients defaulting or failing treatment in this group and further studies are needed particularly .retrospective to explore the matter.

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