| Diulu Kabongo |
| Department of Family Medicine, Stellenbosch |
| December, 2009 |
Abstract |
| Introduction: Tuberculosis and HIV are major public health problems in Botswana. In the face of growing TB notification rates, a low cure rate, human resource constraints and poor accessibility to health facilities, Botswana decided to offer home-based directly observed treatment (DOT) using community volunteers. The aim of this study was to assess the outcomes of home-based (HB) versus facility-based (FB-DOT) in Kweneng West Subdistrict, Botswana and to explore the acceptability of HB- DOT among TB patients, community volunteers and health workers. Methods: A quantitative, observational study using routinely collected TB data from 405 TB patients combined with 20 qualitative in-depth interviews. Results: Overall cure rate for smear positive pulmonary TB patients was 78.5%. Treatment outcomes were not statistically different between FB-DOT and HB-DOT. Contact tracing was significantly better in FB-DOT patients. Interviews revealed advantages and disadvantages for both FB and HB options and that flexibility in the choice or mix of options was important. A number of suggestions were made to improve the HB-DOT programme. Conclusion: HB-DOT is at least as good as FB-DOT in terms of the treatment outcomes, but attention must be given to contact tracing. HB-DOT offers some patients the flexibility they need to adhere to TB treatment and community volunteers may be strengthened by ongoing training and support from health workers, financial incentives and provision of basic equipment. |
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