Tuberculosis intervention program in Senegal improves patient outcomes

Patients with tuberculosis in the West African country of Senegal who participated in an intervention program that included improved communication with health personnel and community involvement had higher cure and treatment completion rates, according to a study in the January 24/31 issue of JAMA: The Journal of the American Medical Association.

Poor adherence to treatment remains a major obstacle in the global fight against tuberculosis (TB). Reasons for nonadherence are complex and involve more than the patients' personal characteristics and attitudes, according to background information in the article. Factors such as the chronic nature of the disease, poverty, and interacting with physicians, nurses, and other health care workers, all affect access to and compliance with treatment. New strategies to improve access and adherence to treatment are needed.

Sylla Thiam, M.D., of the Programme Tuberculose, Dakar, Senegal and colleagues conducted a study to determine the effectiveness of a strategy developed to address the problem of low adherence and improve treatment outcomes in Senegal. The randomized controlled trial included 1,522 patients older than 15 years with newly diagnosed pulmonary TB who were randomly assigned to the intervention (n = 778 patients) or control (n = 744 patients) group. The intervention strategy included reinforced counseling through improved communication between health personnel and patients, decentralization of treatment, choice of directly observed therapy (DOT) supporter by the patient, and reinforcement of supervision activities. In the control group, the usual TB control program procedures remained unchanged. The study was conducted between June 2003 and January 2005 at 16 government district health centers in Senegal.

Treatment was successful for 682 patients (88 percent) in the intervention group compared with 563 patients (76 percent) in the control group. The risk of defaulting from treatment was nearly 60 percent lower in the intervention group (43 patients [5.5 percent] defaulted from treatment in the intervention group vs. 125 patients [16.8 percent] in the control group). The intervention also significantly decreased the time to defaulting since the start of treatment.

"Control of TB depends on effective treatment as well as effective strategies to support the process of care from detection of disease through the completion of appropriate treatment. A key aspect of our approach was to identify, based on qualitative studies, an intervention that would be feasible, sustainable, and fully acceptable by the patients and the health care services. This, we believe, is the path toward making TB control more responsive and reflective of local health systems and social constraints and resources."

"Our results show that the intervention we tested, consisting of a coherent package of sustainable activities targeting altogether health staff, patients, and communities, did improve treatment outcomes. This intervention could now be implemented in a stepwise manner throughout Senegal, and we believe that this approach may be generalized within the context of TB control programs in other resource-poor countries," the authors conclude.