Different challenges, different approaches and related expenditures of community-based tuberculosis activities by international non-governmental organizations in Myanmar

Abstract

BackgroundInternational non-governmental organizations (INGOs) have been implementing community-based tuberculosis (TB) care (CBTBC) in Myanmar since 2011. Although the National TB Programme (NTP) ultimately plans to take over CBTBC, there have been no evaluations of the models of care or of the costs of providing CBTBC in Myanmar by INGOs.MethodsThis was a descriptive study using routinely-collected programmatic and financial data from four INGOs during 2013 and 2014, adjusted for inflation. Data analysis was performed from the provider perspective. Costs for sputum examination were not included as it was provided free of charge by NTP. We calculated the average cost per year of each programme and cost per patient completing treatment.ResultsFour INGOs assisted the NTP by providing CBTBC in areas where access to TB services was challenging. Each INGO faced different issues in their contexts and responded with a diversity of strategies. The total costs ranged from US$ 140 754 to US$ 550 221 during the study period. The cost per patient completing treatment ranged from US$ 215 to US$ 1 076 for new cases and US$ 354 to US$ 1 215 for retreatment cases, depending on the targeted area and the package of services offered. One INGO appeared less costly, more sustainable and patient oriented than others.ConclusionsThis study revealed a wide variety of models of care and associated costs for implementing CBTBC in diverse and challenging populations and contexts in Myanmar. Consequently, we recommend a more comprehensive evaluation, including development of a cost model, to estimate the costs of scaling up CBTBC country-wide, and cost-effectiveness studies, to best inform the NTP as it prepares to takeover CBTBC activities from INGOs. While awaiting evidence from these studies, model of CBTBC that have higher sustainability potential and allocate more resources to patient-centered care should be given priority support.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0263-9) contains supplementary material, which is available to authorized users.

Treatment outcomes among tuberculosis patients in Jeddah, Saudi Arabia: Results of a community mobile outreach directly observed Treatment, Short-course (DOTS) project, compared to a standard facility-based DOTS: A randomized controlled trial

“…The lost-to-follow-up rate of only 3% in our intervention group was much better than the approximately 8% and 10% rates described in the Riyadh [2] and Karachi [23] studies. Some other studies reported a lost-to-follow-up rate of 8–15% [30] , [31] . Bronner et al [30] and Santha et al [32] even reported a rate of 23% and 32% respectively.…”

The community as an active part in the implementation of interventions for the prevention and control of tuberculosis: a scoping review

“…They report that this intervention has been sustained for 8 years due to the collaborative work of the education center, public health department, and the Rochester Healthy Community Association, whose mission is to promote health through a CBPR approach. On the other hand, Han et al (55) conducted a descriptive study in which they mention that a community-based tuberculosis prevention program has greater potential for sustainability by training CHW to form social mobilization working groups that they can train more volunteers and allow the program to be maintained through the years. Therefore, community participation has been shown to lead to significant changes in tuberculosis control.…”

The community as an active part in the implementation of interventions for the prevention and care of tuberculosis: A scoping review

“…They report that this intervention has been sustained for 8 years due to the collaborative work of the education center, public health department, and the Rochester Healthy Community Association, whose mission is to promote health through a CBPR approach. On the other hand, Han et al [62] mention that community tuberculosis prevention programs can be sustained over time when CHWs are trained and social mobilization groups are formed. Considering this evidence, community participation has been shown to lead to significant changes in ending tuberculosis.…”