Researchers root for community-based TB treatment

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The community-based approach to delivering TB treatment is more effective than the family-based strategy, a new study has found.

According to a study that was done in Togo by the International Union Against Tuberculosis and Lung Disease, the World Health Organisation and Togo’s National TB Programme, 93% of participants had favourable outcomes after six months (e.g. cured and/or completed treatment) through a community health worker-led approach to supervising treatment intake, compared to 78% through a family member supervising treatment intake.

The International Union Against Tuberculosis and Lung Disease is a global health organisation and a global leader in ending TB, with presence in over 140 countries.

Internationally, effective TB treatment is done through the directly observed treatment by a health worker, community health worker-based and family-based.

Under the study that started in April 2021 up to January 2022, experts evaluated two innovative approaches to directly observed treatment -- community health worker-based and family-based approach.

The study examined sputum smears conversions in month two and favourable treatment outcomes at month six, and identified factors that influenced these outcomes.

In a recent online interview with New Vision, Dr Kobto Koura, Director of TB at the International Union Against Tuberculosis and Lung Disease, said results showed that the community health worker-based approach had a significantly higher rate of sputum smear conversions after two months, 92% of participants, compared to 74% through the family-based approach.

He also said the study found that smoking had a significantly negative impact on treatment outcomes for both treatment approaches.

Only 52% of tobacco users achieved smear conversions at month two, compared to 89% of non-smokers. While approximately one-in-two smokers had unfavourable treatment outcomes (48%), just 8% of non-smokers had unsuccessful outcomes.

The research paper was recently published in the International Journal of Tuberculosis and Lung Disease.

Dr Koura said: “These results provide us with vital insight into the most effective mechanism for delivering TB treatment at a community level in Togo, which will enable the NTP to make more informed decisions about how to support people with TB.

“The use of tobacco, significantly associated with outcomes, also suggests that a smoking cessation component may be a valuable addition to community-based TB treatment.”

“In addition to the results, the project has demonstrated two important elements. The first is the real-time adaptability of African NTP, and the second is that the community should be involved in NTP activities and can improve results.”

“We thank people with TB and colleagues for their involved in this project.”

The project was performed in eight TB clinics within high TB burden regions, of which four implemented CHW-DOT and four implemented FB-DOT.

Implications of the study on TB treatment in Africa

Dr Koura told New Vision that in several African countries, health workers still request patients to visit TB clinics each day for their treatment (directly observed treatment), but with the results of the study, health workers no longer need to request patients to go to TB clinics each day for their treatment. “The two approaches are community approaches. But the results are better with the community health care Worker. So we can count on Community Health Care Workers as long as they have been well trained,” he said.

In Uganda, village health teams have not yet been trained to supervise treatment of TB patients. However, organisations like Uganda Stop TB Partnership train TB survivors to counsel and supervise treatment of TB patients.

Fred Ebil, the founder of Fellowship of TB Survivors, an organisation that advocates for the interests of TB survivors, based in Kampala, says: “We need sensitisations not only on how people should treat TB patients, but also encourage people to carry out testing. TB is a highly fatal disease, but people hardly test for it. They only test when they start coughing.”

In Africa, TB was the second leading cause of death from a single infectious agent, with nearly 2.5 million people falling ill and 424 000 lives lost in 2022.