Effectiveness of community-based DOTS strategy on tuberculosis treatment success rates in Namibia

Kibuule, Dan; Rennie, Timothy; Ruswa, Nunurai; Mavhunga, Farai; Thomas, Albertina; Amutenya, R; Law,; Günther, Gunar; Ette, E; Godman, B.; Verbeeck, Roger K.

doi:10.5588/ijtld.17.0785

Cited by 17 publications

(17 citation statements)

References 20 publications

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“…We believe this is the first study to qualitatively identify key factors influencing prescribing practices and NSTG compliance across disease areas building on assessments of guideline adherence in specific treatment and disease areas as well as ways to improve the content and pragmatism of national STGs among sub-Saharan African countries [10,[16][17][18]. This is a concern given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa and their impact on morbidity, mortality and costs [5,[19][20][21][22][23][24][25][26][27]. The prescribing indicators were typically sub-optimal compared with the Namibia and WHO/INRUD standards, similar to other African countries [9,15].…”

Section: Discussionmentioning

confidence: 99%

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

et al. 2020

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Background The World Health Organization estimates that over 50% medicines are prescribed inappropriately and the main driver of antimicrobial resistance globally. There have only been a limited number of studies evaluating prescribing patterns against national standard treatment guidelines (STGs) in sub-Saharan African countries including Namibia. This is important given the high prevalence of both infectious and non-infectious diseases in sub-Saharan Africa alongside limited resources. Objective Our aim was to assess prescribing practices and drivers of compliance to National guidelines among public health care facilities in Namibia to provide future guidance. Setting Three levels of public healthcare in Namibia. Method A mixed method approach including patient exit and prescriber interviews at three levels of health care in Namibia, i.e. hospital, health centre and clinic. Main outcome measures Medicine prescribing indicators, compliance to and attitudes towards National guidelines. Results Of the 1243 prescriptions analysed, 73% complied with the STGs and 69% had an antibiotic. Of the 3759 medicines (i.e. mean of 3.0 ± 1.1) prescribed, 64% were prescribed generically. The vast majority of prescribers were aware of, and had access to, the Namibian STGs (94.6%), with the majority reporting that the guidelines are easy to use and they regularly refer to them. The main drivers of compliance to guidelines were programmatic, that is access to up-to date objective guidelines, support systems for continued education on their use, and ease of referencing. Lack of systems to regulate noncompliance impacted on their use. Conclusion Whilst the findings were encouraging, ongoing concerns included limited prescribing of generic medicines and high use of antibiotics. A prescribing performance management system should be introduced to improve and monitor compliance to prescribing guidelines in public healthcare.

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Section: Discussionmentioning

confidence: 99%

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

et al. 2020

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“…15 29 Conversely, the study result is comparable to a study reported from Mongolia, whereby patients who opted for CB-DOTS showed a higher cure rate than those who attended the FB-DOTS approach (89.9% vs 77.2%) 22 and a study in Namibia in which the cure rate was significantly increased with the implementation of CB-DOTS. 20 Our finding could be explained by the fact that the CB-DOTS option is more accessible to patients, as it is convenient and nearer to their home. 30 In addition, CB-DOTS is flexible in terms of time and place for patients to obtain DOTS service compared with the FB-DOTS approach.…”

Section: Discussionmentioning

confidence: 76%

“…13 Previous studies in different countries have shown that CB-DOTS is more effective than the FB-DOTS approach. [14][15][16][17][18][19][20] In the Jimma Zone, where this study was conducted, only 23% of the health posts provided TB treatment at the community level during the study period. To the best of our knowledge, a comparative study on CB-DOTS versus FB-DOTS delivery approaches has not been conducted in Southwest Ethiopia.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Treatment outcomes of patients with drug-sensitive tuberculosis under community-based versus facility-based directly observed treatment, short course strategy in Southwest Ethiopia: a prospective cohort study

et al. 2021

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ObjectiveTo compare tuberculosis (TB) treatment outcomes and associated factors among patients attending community-based versus facility-based directly observed treatment, short course (DOTS).DesignA prospective cohort study.SettingThe study was conducted in Southwest Ethiopia. There were seven hospitals (five primary, one general and one specialised), 120 health centres and 494 health posts.ParticipantsA total of 1161 individuals consented to participate in the study (387 patients under community-based DOTS (CB-DOTS) and 774 patients under facility-based DOTS (FB-DOTS)). Individuals who could not respond to the questions, mentally or critically ill patients, and those less than 15 years old, were excluded from the study.Primary outcome measureTB treatment outcomes were compared among patients under CB-DOTS versus FB-DOTS. Risk ratio (RR), risk difference (RD) and confidence interval (CI) were calculated among the study groups. In addition, χ2 or Fisher’s exact tests were used to compare group differences, with a p value of <0.05 considered statistically significant.ResultsPatients who opted for CB-DOTS were more likely to be cured by 12% than those who opted for FB-DOTS (RR=1.12, 95% CI=0.96 to 1.30). Patients under CB-DOTS had a lesser risk of death (RR=0.93, 95% CI=0.49 to 1.77) and a lower risk of treatment failure (RR=0.86, 95% CI=0.22 to 3.30) than those under FB-DOTS. Furthermore, patients who opted for CB-DOTS were less likely to have a positive sputum smear result at the end of the treatment period (p=0.042) compared with their counterparts.ConclusionThe study showed that CB-DOTS is more effective than FB-DOTS in terms of improving cure rate and sputum conversion rate, as well as lowering treatment failure rate. Our findings show the need for scaling up and a further decentralisation of CB-DOTS approach to improve access to TB treatment service for the rural community.

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“… 6 , 7 , 20 Fortunately, with the adjustment of treatment strategies in recent years, there are declining trends in loss to follow up (LTFU) and increasing trends in the success rate of TB treatment. 21 , 22 Kibuule et al reported that since the expansion of facility-based DOTS programme to community-based DOTS programme in Namibia in 2005, 23 the mean annual treatment success rate increased by approximately 20% when comparing the pre-intervention (1996–2005) and the post-intervention (2005–2015) periods.…”

Section: Discussionmentioning

confidence: 99%

Development of a nomogram for predicting treatment default under facility-based directly observed therapy short-course in a region with a high tuberculosis burden

Wang

2021

Therapeutic Advances in Infection

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Background: Poor adherence to tuberculosis (TB) treatment is a substantial barrier to global TB control. The aim of this study was to construct a nomogram for predicting the probability of TB treatment default. Methods: A total of 1185 TB patients who had received treatment between 2010 and 2011 in Peru were analyzed in this study. Patient demographics, social, and medical information were recorded. Predictors were selected by least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram for predicting TB treatment default was constructed by using multivariable logistic regression analysis. Bootstrapping method was applied for internal validation. Calibration and clinical utility of the nomogram was also evaluated. Results: The incidence of TB treatment default among the study patients was 11.6% (138/1185). Six predictors (secondary education status, alcohol use, illegal drug use, body mass index, multidrug-resistant tuberculosis, and human immunodeficiency virus serostatus) were selected through the LASSO regression analysis. A nomogram was developed based on the six predictors and it yielded an area under the curve (AUC) value of 0.797 [95% confidence interval (CI), 0.755–0.839]. In the internal validation, the AUC achieved 0.805 (95% CI, 0.759–0.844). Additionally, the nomogram was well-calibrated, and it showed clinical utility in decision curve analysis. Conclusion: A nomogram was constructed that incorporates six characteristics of the TB patients, which provides a good reference for predicting TB treatment default.

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Effectiveness of community-based DOTS strategy on tuberculosis treatment success rates in Namibia

Cited by 17 publications

References 20 publications

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

Compliance to prescribing guidelines among public health care facilities in Namibia; findings and implications

Treatment outcomes of patients with drug-sensitive tuberculosis under community-based versus facility-based directly observed treatment, short course strategy in Southwest Ethiopia: a prospective cohort study

Development of a nomogram for predicting treatment default under facility-based directly observed therapy short-course in a region with a high tuberculosis burden

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