Free Content Tuberculosis treatment in Nepal: a rapid assessment of government centers using different types of patient supervision

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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.

Keywords: outcome and process assessment (health care); treatment outcome; tuberculosis

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: October 1, 2001

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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