Community-Based TB Care: Experience from ... - CORE Group

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Community Based TB care through former TB patients’ social clubsAcknowledgementThis document, “Community Based TB Care, Temeke experience” is one of the outputs of theNational Tuberculosis and Leprosy Programme (NTLP) implemented in Temeke, Dar es Salaamby Temeke Municipal Council through TB control programme in partnership with the NorwegianHeart and Lung Patients Association (LHL). NTLP would like to thank all those who contributedin one way or another to the success of the programme. Special thanks go to Dr. EliudWandwalo who gave Community based TB care a priority in his PhD thesis and the LHL whofunded the research and later keeps on financially support former TB patients in Temeke.The NTLP would also like to extend more thanks to the DMO, DTLCs, health workers in TBcentres in Temeke and MUKIKUTE administration for their cooperation during thedocumentation. Likewise, the contribution of all MUKIKUTE members in the whole process ofsupporting TB patients and community sensitization cannot go unmentioned.Last but not least, more thanks are extended to the Temeke RTLC, Wailes TB/HIV officer andthe DTLC for their valuable contributions towards documentation of best practice of communityBased TB care in Temeke Municipality.Experience from TemekePage iii
Community Based TB care through former TB patients’ social clubsForewordTuberculosis (TB) is among the top ten causes of global mortality and morbidity accounting forabout 26% of all preventable deaths. TB is the third leading killer of adults behind Malaria andAcquired Immune-deficiency syndrome (AMMP, 2003). In Tanzania more than 63,000 new TBpatients are notified annually and this is mainly fuelled by HIV epidemic. Other factors likepopulation growth and urban overcrowding have also contributed to this increase. Casedetection has remained below 50% compared to WHO estimates of 70% (Global report, 2009).This under reporting could be due to low community sensitization, stigma, and passive casefinding approach.In Tanzania, TB patients are treated under health facility or community based Directly ObservedTreatment (DOT). Community based DOT includes choosing a local ‘treatment supporter’ tosupervise the patient when taking medications and encourage them to comply in the wholecourse of treatment. This approach goes beyond the existing health services and enhancesmore allies including cured TB patients. Community-based approach also empowers andinvolves former TB patients in their capacity to help other TB patients to overcome difficultiesduring treatment.Successful TB treatment requires at least 6-8 months of treatment to ensure cure and preventthe development of multi-drug resistant TB (MDR-TB). Thus compliance throughout the courseof treatment is of paramount importance.Various studies on involvement of local TB treatment supporters conducted in different areasworldwide including Temeke, Tanzania. In Temeke the study involved former TB patients.The effectiveness of this approach revealed in 2004 in a randomized controlled trial conductedin Temeke region of NTLP where by the effectiveness of community-based DOT usingguardians and former TB patients was done to compare hospital-based DOT in an urban settingin Tanzania. The findings from both DOT options gave similar treatment outcomes at a reducedcost. It was therefore concluded that community-based DOT was as effective as health facilitybasedDOT and can achieve good treatment outcomes (Wandwalo et al, 2004).Another study conducted in the same region in 2005 to determine the cost effectiveness ofhealth facility and community based TB DOTS in an urban setting in Tanzania revealed that, thetotal cost of treating a patient with conventional health facility based DOT and community basedDOT were $ 145 and $ 94 respectively. Cost fell by 27% for health services and 72% forpatients. Indirect costs were as important as direct costs, contributing to about 49% of the totalpatient's cost. The main reason for reduced cost was less number of visits to TB clinics.Community based DOT was more cost-effective at $ 128 per patient successfully treatedcompared to $ 203 for a patient successfully treated with health facility based DOT (Wandwaloet al, 2005).These results persuaded NTLP in collaboration with the Norwegian heart and Lung PatientsAssociation (LHL) to establish former TB social club known as “Mapambano dhidi ya Kifua kikuuna UKIMWI, Temeke” MUKIKUTE in 2005 for the purpose of strengthening community basedExperience from TemekePage iv
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