The role of treatment supporters in TB management
Presented by Nelson Seruma (Uganda).
Kamwokya Christian Caring Community, Monitoring and Evaluation, Kampala, Uganda
Issues: Non-adherence to TB treatment is receiving considerable attention among HIV/AIDS implementers. Whereas the Ministry of Health developed different strategies to ensure adherence to TB treatment, including TB DOTS, and increased availability of drugs, there is lack of network systems among patients, their families, and health institutions so as to tackle other challenges that impact on adherence. Most health centers dispense and do not link up with the community.
Description: KCCC catchment area was divided into zones, each zone allocated to Community Health Workers (CHWs) some of whom were EX-TB patients. Lists of patients from each zone are produced and distributed among the experts for follow up. On clinic days TB patients are educated on: importance of completing treatment, role of expert supporters, and consent to home visiting. Treatment supporters fill forms on every visit to the patients. They help the patients fill in their treatment cards. Every month, filled in forms are collected at the clinic, data entered, analyzed, and collated with patient routine follow up visit data. Nurses make routine community follow up visits to support the patients and treatment supporters. Data has been extracted from TB register, and project reports, and analyzed using SPSS version 12.0.
Lessons learned: 33 CHWs were identified and trained in 2005. Between 2006 and 2007, 360 patients were treated for TB and overall, 73% adhered to the treatment. During the same period, 238 patients were co-infected with HV/TB. By the end of 2005, default rates averaged at 25%. This reduced to 11% in 2007 among patients visited by Ex-TB supporters. CHWs have reached a total of 120 TB patients in their homes.
Next steps: The success of TB treatment depended on the linkages between the clinic, communities, families, and CHWs. TB treatment should look beyond the DOTS approach, to more sustainable methods, like expert treatment supporters (CHWs).
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