Decentralising DOT for drug-susceptible TB from the health facilities to the community level in Togo.

In Togo, the COVID-19 pandemic paved the way for decentralising directly observed treatment (DOT) to the community level through the evaluation of two innovative community-based DOT approaches-a community health worker-based (CHW-DOT) and family-based (FB-DOT). METHODS We conducted an observational prospective study from April 2021 to January 2022. Sputum conversion at Month 2 and favourable treatment outcomes at Month 6 were assessed and compared between the two groups. Sociodemographic and clinical factors related to these outcomes were identified. RESULTS A total of 182 TB patients were enrolled. The CHW-DOT group had significantly increased odds of sputum conversion (aOR 2.95, 95% CI 1.09-7.98) and lower odds of unsuccessful treatment outcomes (aOR 0.37, 95% CI 0.13-1.1). Non-smokers had 4.85 higher odds of converting than smokers (aOR 4.85, 95% CI 1.76-13.42) and lower odds of an unsuccessful treatment than smokers (aOR 0.11, 95% CI 0.04-0.32). CONCLUSION CHW-DOT is associated with higher sputum smear conversion rates and a more favourable treatment outcome. The use of tobacco, significantly associated with outcomes, also suggests that a smoking cessation component may be a valuable adjunct to a CHW-DOT approach during TB treatment..

Medicinal plant use and adherence problems to TB treatment.

BACKGROUND: Good adherence is essential in the treatment of TB. The aim of this study was to describe medication consumption patterns and to assess factors associated with adherence to TB treatment among TB patients in Lomé, Togo.METHODS: A cross-sectional study was conducted among TB patients in 10 health structures in Lomé from September 2019 to January 2020. TB patients aged ≥18 years and under treatment for at least 2 months were eligible for this study. Adherence to TB treatment was assessed using the Girerd compliance test.RESULTS: A total of 195 TB patients (61.5% male) with a median age of 35 years (IQR 27-44) were recruited. TB-HIV coinfection was 11.3%. Polypharmacy (≥5 medications/day) and using medicinal plants were observed in respectively 6.2% and 42.6% of patients. Prevalence of TB treatment adherence problems was 68.2% (95% CI 61.2-74.7). Being <35 years (aOR 2.79; P = 0.005) and taking medicinal plants (aOR 4.31; P < 0.001) were associated with TB treatment adherence problems.CONCLUSION: Treatment adherence problems, a major obstacle to TB elimination, are highly prevalent in TB patients in Lomé, and were associated with the use of medicinal plants. Reasons for the use of medicinal plants should be documented in order to propose appropriate interventions to reinforce adherence to TB treatment.