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.