Coping with Africa's increasing tuberculosis burden: Are community supervisors an essential component of the DOT strategy?

Wilkinson, David and Davies, Geraint R. (1997) Coping with Africa's increasing tuberculosis burden: Are community supervisors an essential component of the DOT strategy?. Tropical Medicine & International Health, 2 7: 700-704. doi:10.1046/j.1365-3156.1997.d01-358.x


Author Wilkinson, David
Davies, Geraint R.
Title Coping with Africa's increasing tuberculosis burden: Are community supervisors an essential component of the DOT strategy?
Journal name Tropical Medicine & International Health   Check publisher's open access policy
ISSN 1360-2276
1365-3156
Publication date 1997-07
Sub-type Article (original research)
DOI 10.1046/j.1365-3156.1997.d01-358.x
Volume 2
Issue 7
Start page 700
End page 704
Total pages 5
Place of publication Oxford, England
Publisher Blackwell Science
Language eng
Subject 1103 Clinical Sciences
1108 Medical Microbiology
1117 Public Health and Health Services
Abstract Tuberculosis incidence in Africa is increasing dramatically and fragile health systems are struggling to cope. Potential coping capacity may lie within affected communities but this capacity needs to be harnessed if tuberculosis is to be controlled. Since 1991 all patients with tuberculosis in Hlabisa health district, South Africa have been eligible for community-based directly observed therapy (DOT). Patients are supervised either by a health worker (HW) in a village clinic, or in the community by a community health worker (CHW) or a volunteer lay person (VLP). Tuberculosis incidence increased from 312 cases in 1991 to 1230 cases in 1996. By December 1995, 2622 (87%) of 3006 patients had received DOT, supervised mainly by VLP (56%) but also by HW (28%) and CHW (16%). The proportion supervised by HW fell from 46% in 1991 to 26% in 1995 (P < 0.0001). More patients supervised by VLP (85%) and CHW (88%) than by HW (79%, P = 0.0008) completed treatment. Case-holding by HW declined more between 1991 and 1995 (84% to 71%, P = 0.02) than did case-holding by both CHW (95% to 90%, P = 0.7) and VLP (88% to 84%, P = 0.4). Mortality was similar (4-6%) and stable over time, irrespective of the supervisor. High tuberculosis treatment completion rates are achievable and sustainable for several years in resource-poor settings despite a massively increased case load if community resources are harnessed. Patients may be more effectively supervised by voluntary lay people than by health workers under these circumstances, without being placed at increased risk. These findings suggest that community supervisors may be an essential component of any DOT strategy.
Keyword Tuberculosis
Control
Directly Observed Therapy
South Africa
HIV
Mortality
Countries
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Tue, 07 Sep 2010, 13:06:12 EST