The Effects on Tuberculosis Treatment Adherence from Utilising Community Health Workers: A Comparison of Selected Rural and Urban Settings in Kenya

Abstract

IntroductionCommunity Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. To support Kenya's policy on engagement of CHWs for tuberculosis (TB) control, there is need to demonstrate effects of utilising them.ObjectivesThis study assessed TB treatment adherence among patients who utilised CHWs in management of their illness in comparison to those who did not in urban and rural settings.MethodsA retrospective cohort study was conducted in selected health facilities using standard clinical records for each TB patient registered for treatment between 2005 to 2011. Qualitative data was collected from CHWs and health care providers.ResultsThe study assessed 2778 tuberculosis patients and among them 1499 (54%) utilized CHWs for their TB treatment. The urban setting in comparison with the rural setting contributed 70% of patients utilising the CHWs (p<0.001). Overall treatment adherence of the cohort was 79%. Categorizing by use of CHWs, adherence among patients who had utilized CHWs was 83% versus 68% among those that had not (p<0.001). In comparison between the rural and urban settings adherence was 76% and 81.5% (p<0.001) respectively and when categorized by use of CHWs it was 73% and 90% (p<0.001) for the rural and urban set ups respectively. Utilisation of CHWs remained significant in enhancing treatment adherence in the cohort with unadjusted and adjusted ORs; OR 2.25, (95% 1.86–2.73) p<0.001 and OR 1.98 (95% 1.51–2.5) p<0.001 respectively. It was most effective in the urban set-up, OR 2.65 (95% 2.02–3.48, p<0.001) in comparison to the rural set up, OR 0.74 (95% 0.56–0.97) p = 0.032.ConclusionUtilisation of CHWs enhanced TB treatment adherence and the best effects were in the urban set-up.

Integrating tuberculosis research with public health infrastructure: Lessons on community engagement from Orizaba, Mexico

“…For example, by humanising the research process and making research participants feel valued, the Consorcio might have successfully nurtured participants' faith in self-investment-the belief that it is 'worth' taking active steps to care for oneself-in ways that may not have been familiar to them prior to their experiences with the Consorcio. This would appear consistent with the impact healthcare personnel's attitudes have been documented to have in other regions 17 .…”

“…Our findings support the potential for a positive contribution of CE to the epidemiological outcomes of a TB treatment trial. However, further research is needed on the range of possible ways an enhanced "human infrastructure" of respectful relationships 17 can have an impact on the behavior of individual participants during a trial. Pursuing these lines of inquiry may demonstrate that CE represents a critically under-developed resource for disease control more generally.…”

Implementation status of household contact tuberculosis screening by health extension workers: assessment findings from programme implementation in Tigray region, northern Ethiopia

“…HH contacts of index TB cases those who had TB TTS were nearly 3 times more likely to be screened for TB than those without TTS. This might be due to TTS play a role in improving the knowledge of the index cases [31][32][33]. It is also possible that the level of knowledge of HH members and TTS could enhance the capacity of the HH members to be screened or capacity of TTS to create awareness and screen respectively.…”

Community health volunteers’ contribution to Tuberculosis patients notified to National Tuberculosis program in Kenya

“…These findings are consistent with other studies which have shown that utilization of community health volunteers for household contact screening can positively affect the total patients notified to the national TB program. (7)(8)(9)(10)(11)(12) The increased number of TB cases reported from the community health volunteers' household screening and referral could be attributed to training of Community Health Volunteers and the Community Health extension workers to support active case finding activities that included Household TB screening. Better documentation of community referrals in the TB register was also observed during this period.…”