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Improved TB treatment outcomes: The role of community structures in the TB ‘continuum of response’ in South Africa

Improved TB treatment outcomes: The role of community structures in the TB ‘continuum of response’ in South Africa
Publication date: 
Nov 2019
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Background and challenges to implementation

As part of a comprehensive response to the TB epidemic in South Africa, community-based intervention was identified as a core pillar in managing the scourge of TB. Key role players in community-based interventions include local non-governmental organisations (NGOs), faith-based NPOs and private general practitioners. The package of interventions used by these organisations include TB awareness and education, treatment adherence support (DOT support), TB screening and case-finding. Care Ministry NGO was funded by the USAID TB South Africa Project to support 185 DR-TB patients in sub-districts A, B, and C, Nelson Mandela Bay Metro across 18 public health facilities. An outcome analysis was conducted to measure impact of the NGO in improving TB outcomes.

Intervention

A cohort analysis was conducted for all DR-TB patients registered on TB treatment in 2015 and 2016, supported by the NGO. In total, 105 (25 patients in 2015 cohorts and 80 patients in the 2016 cohort) patients that received treatment adherence support were included in the analysis. Comparison was made on treatment outcomes of the 105 patients against patients not supported by the NGO. Treatment outcome indicators considered for analysis were TB treatment success rate (TSR), lost to follow-up rate (LTF) and death rates.

Results

Treatment success rate (TSR) in the 2015 cohort was 56% among supported DR-TB patients supported by the NGO compared to a TSR of 49% for DR-TB patients under the standard Department of Health care. TSR in the 2016 cohort was 69% among DR-TB patients supported by the NGO, compared to 43% for patients receiving standard Department of Health care. The same results were observed for proportion of lost to follow-up and patients who died. In 2015, 21% of DR-TB patients receiving only standard care were lost to follow-up, compared to 4% of DR-TB patients receiving NGO support, 17,3% and 0% in 2016 respectively.

Odds of being lost to follow-up at any point during treatment were significantly lower among NGO patients, compared to standard of care patients (OR=0.05, p<0.001, 95% CI [0.01 – 0.39]. For mortality rate, patients receiving NGO care had significantly lower odds of death during treatment (OR=0.08, p<0.001, 95% CI [0.03 – 0.27].

Conclusion

Analysis suggests that the odds of both LTFU and death were significantly lower among NGO-supported patients compared to those who received the standard of care alone. Results further show that NGO network model improve patient retention in care and the likelihood of treatment success and other favourable outcomes.