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Free Content Lay health worker-supported tuberculosis treatment adherence in South Africa: an interrupted time-series study

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Abstract:

SETTING: Better integration of treatment support for people living with tuberculosis (TB) and human immuno-deficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) is a challenge in many settings, and has been identified as a service priority.

OBJECTIVE: To determine the impact, compared to directly observed therapy, of a TB treatment intervention modelled on the community antiretroviral treatment (ART) support programme in South Africa.

DESIGN: An interrupted time-series design was used, including five intervention clinics and five comparison clinics. Data were collected from January 2005 to March 2008 and analysed using Poisson regression.

RESULTS: Between April 2007 and March 2008, a total of 71% of all new TB patients starting treatment at the intervention clinics were placed on the intervention. There were no significant differences in cure or treatment success rates for new TB patients between intervention and comparison clinics. There was a small improvement in smear conversion rates in intervention clinics when compared to comparison clinics.

CONCLUSION: The new model does not result in significantly different TB cure and treatment success rates, but does result in small improvements in smear conversion rates for smear-positive TB patients. The model holds potential for the better integration of TB and ART support.

Keywords: adherence; directly observed therapy; interrupted time series; lay health workers; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa; Division of Global Health, Karolinska Institute, Stockholm, Sweden 2: Health Systems Research Unit, Medical Research Council of South Africa, Cape Town, South Africa; Norwegian Knowledge Centre for the Health Services, Oslo, Norway 3: Biostatistics Unit, Medical Research Council of South Africa, Cape Town, South Africa 4: Division of Global Health, Karolinska Institute, Stockholm, Sweden

Publication date: 2011-01-01

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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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