Tuberculosis in Swaziland: A Health Needs Assessment in Preparation for a Community-Based Programme

Pushpananthan, Suresh; Walley, John; Wright, Jo

doi:10.1177/004947550003000412

Cited by 9 publications

(6 citation statements)

References 7 publications

(1 reference statement)

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“…17,27,34 Furthermore, there is copious evidence to suggest that TB can accelerate the progression of HIV infection and thus reduce the chances of survival. 3,35 In the present study, the rate of morbidity was higher amongst patients included in group 1 (20.8%) compared to group 2 (6.3%), although the difference was not statistically signifi cant (P = 0.816). Interfering factors, such as the distribution of patients between the ADT and SAE programs, may have contributed to this result despite the similarity of the other parameters between the two groups.…”

Section: Discussioncontrasting

confidence: 58%

“…If all of these criteria are met, the control of TB is one of the most cost-effective health interventions. 3 However, the number of TB cases is increasing worldwide, and the HIV pandemic is considered to be one of its major causes. 4,5 In developed countries an increase in cases was due to coinfection with HIV, and paradoxically, the increase in longevity with the emergence of TB in the elderly.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the effectiveness of a home-based care program for patients coinfected with tuberculosis and human immunodeficiency virus after discharge from a reference hospital in South-Eastern Brazil

Bento¹,

Pedroso²

2010

Braz J Infect Dis

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We declare no confl ict of interest. ABSTRACTThe effectiveness of tuberculosis treatment delivered by a home-based care program to patients coinfected with HIV was compared with that of a service provided by outpatient departments. A retrospective study was made of a cohort of coinfected patients discharged from hospital between January 1998 and December 2002 who had been followed-up for one year within one of these programs. Two-hundred-and-forty-three patients who met the inclusion criteria were grouped according to their treatment program (group 1 received home-based care; group 2 attended outpatient departments) and then paired one-to-one across the groups by gender, age and level of education. Only 48 patients from each group could be paired. Apart from the duration of HIV infection, there were no statistically signifi cant differences (P < 0.05) between patients in the two groups with respect to social-demographic status and clinical or laboratory characteristics. In group 1, 75.0% of patients attained successful tuberculosis treatment compared with 72.9% of those in group 2 (P = 0.816). Treatment was abandoned by 22.9% of patients in group 1 and by 54.2% of those in group 2 (P = 0.008). The death rate within one year after discharge was 20.8% for group 1 compared with 6.3% for group 2 (P = 0.334). Although both programs achieved a similar success rate in the treatment of tuberculosis, patients receiving outpatient care were three to eight-times more likely to abandon the program. The importance of assigning patients at-risk of abandoning treatment to a home-based care program after discharge from hospital is emphasized.

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Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Assessment of the effectiveness of a home-based care program for patients coinfected with tuberculosis and human immunodeficiency virus after discharge from a reference hospital in South-Eastern Brazil

Bento¹,

Pedroso²

2010

Braz J Infect Dis

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“…Studies in our synthesis reported that patients stopped treatment because they felt better and thought that they were cured [23,24,39,40,45,47,49,51] or because their symptoms abated [47,52,53]. Some studies noted that patients who felt worse than before treatment [23,24,32] or saw no improvement in their condition [22–24,46] might be more likely to interrupt treatment.…”

Section: Resultsmentioning

confidence: 99%

“…Patients could “become tired” of taking medications [26,30,40,44,45], discontinuing because of the length of treatment [38,40,45,46], the number of tablets [24], or fear of painful injections or drugs [29,47], as noted by both providers and patients.…”

Section: Resultsmentioning

confidence: 99%

Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research

et al. 2007

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BackgroundTuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence.Methods and FindingsWe searched 19 electronic databases (1966–February 2005) for qualitative studies on patients', caregivers', or health care providers' perceptions of adherence to preventive or curative TB treatment with the free text terms “Tuberculosis AND (adherence OR compliance OR concordance)”. We supplemented our search with citation searches and by consulting experts. For included studies, study quality was assessed using a predetermined checklist and data were extracted independently onto a standard form. We then followed Noblit and Hare's method of meta-ethnography to synthesize the findings, using both reciprocal translation and line-of-argument synthesis. We screened 7,814 citations and selected 44 articles that met the prespecified inclusion criteria. The synthesis offers an overview of qualitative evidence derived from these multiple international studies. We identified eight major themes across the studies: organisation of treatment and care; interpretations of illness and wellness; the financial burden of treatment; knowledge, attitudes, and beliefs about treatment; law and immigration; personal characteristics and adherence behaviour; side effects; and family, community, and household support. Our interpretation of the themes across all studies produced a line-of-argument synthesis describing how four major factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors; and personal factors. The findings of this study are limited by the quality and foci of the included studies.ConclusionsAdherence to the long course of TB treatment is a complex, dynamic phenomenon with a wide range of factors impacting on treatment-taking behaviour. Patients' adherence to their medication regimens was influenced by the interaction of a number of these factors. The findings of our review could help inform the development of patient-centred interventions and of interventions to address structural barriers to treatment adherence.

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“…The trial was preceded by a health needs assessment that included analysis of routine data, observation of clinical practice and interviews with staff and patients. Swaziland has a rapidly rising TB case detection rate which reflects the increasing incidence and prevalence of HIV (Pushpananthan et al 2000). For the baseline year prior to the intervention, there were major omissions in the TB register.…”

Section: Methodsmentioning

confidence: 99%

Direct observation of treatment for tuberculosis: a randomized controlled trial of community health workers versus family members

Wright

Walley

Philip

et al. 2004

Tropical Med Int Health

134

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SummaryWe implemented community-based direct observation of treatment, short course (DOTS), including a randomized controlled trial of direct observation either by community health workers (CHWs) or family members, under operational conditions in a region of Swaziland. There was a high death rate of 15%, due to the high HIV rates in the region. There was no significant difference in the cure and completion rate between direct observation of treatment by CHWs and family members [2% difference (95% CI )3% to 7%), exact P ¼ 0.52]. A before-and-after comparison of outcomes demonstrated that the cure and treatment completion rate improved from a baseline of 27-67% following implementation of community-based DOTS. We conclude that community-based tuberculosis DOTS can improve successful outcomes of treatment. However, direct observation can be undertaken effectively using either daily family or CHW supervision. The choice of treatment supporter should be based on access, patient preference and availability of CHW resource.

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Tuberculosis in Swaziland: A Health Needs Assessment in Preparation for a Community-Based Programme

Cited by 9 publications

References 7 publications

Assessment of the effectiveness of a home-based care program for patients coinfected with tuberculosis and human immunodeficiency virus after discharge from a reference hospital in South-Eastern Brazil

Assessment of the effectiveness of a home-based care program for patients coinfected with tuberculosis and human immunodeficiency virus after discharge from a reference hospital in South-Eastern Brazil

Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research

Direct observation of treatment for tuberculosis: a randomized controlled trial of community health workers versus family members

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