Tuberculosis treatment in Nepal: a rapid assessment of government centers using different types of patient supervision
Abstract:SETTING: Urban and periurban government tuberculosis (TB) treatment clinics in Nepal.
OBJECTIVE: To assess TB treatment supervision strategies and outcomes.
DESIGN: Three types of treatment centers were selected according to intensity of treatment supervision: Group A—all patients supervised by directly observed therapy (DOT) at the treatment center during the intensive phase; Group B—flexible DOT where patient-nominated treatment supervisors include community or family members; Group C—drugs dispensed monthly and no supervised treatment. The cohort studied comprised all new patients starting treatment during a 5-month period in 1996 (n = 759).
RESULTS: At group A treatment centers, 100% of patients had daily DOT supervised by treatment center staff during the intensive phase. At group B sites, 75% of nominated supervisors were family or community members and 13% of patients had no supervisor. At group C sites 93% of patients were unsupervised. Bacteriologically confirmed cure rates for smear-positive patients were 91% (95%CI 80.3–97.2) for A sites, 57% (95%CI 48.8–64.0) for B, and 34% (95%CI 25.1–40.4) for C. Treatment centers with the best results had good access to laboratory facilities, uninterrupted drug supply, longer clinic hours, standardized TB case management, and support from a non-governmental organization.
CONCLUSION: At government facilities in Nepal, only group A treatment centers achieved World Health Organization global targets for cure. Group B treatment centers showed better outcomes than unsupervised therapy but did not achieve cure targets. Rapid low-cost assessments to collect data that are not routinely reported can improve the evaluation of program aspects such as supervision strategies.
Document Type: Regular Paper
Affiliations: 1: Rollins School of Public Health, Emory University, Atlanta, Georgia, USA 2: Nuffield Institute for Health, University of Leeds, Leeds, UK and National Tuberculosis Center, Thimi, Kathmandu Valley, Nepal 3: Nuffield Institute for Health, University of Leeds, Leeds, UK and Public Health Department, Montreal, Canada 4: National Tuberculosis Center, Thimi, Kathmandu Valley, Nepal and United Mission to Nepal, Kathmandu, Nepal 5: National Tuberculosis Center, Thimi, Kathmandu Valley, Nepal
Publication date: 2001-10-01
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