Tuberculosis treatment in nepal: a rapid assessment of government centers using different types of patient supervision.
Int J Tuberc Lung Dis
; 5(10): 912-9, 2001 Oct.
Article
em En
| MEDLINE
| ID: mdl-11605884
ABSTRACT
SETTING:
Urban and periurban government tuberculosis (TB) treatment clinics in Nepal.OBJECTIVE:
To assess TB treatment supervision strategies and outcomes.DESIGN:
Three types of treatment centers were selected according to intensity of treatment supervision Group A-all patients supervised by directly observed therapy (DOT) at the treatment center during the intensive phase; Group B-flexible DOT where patient-nominated treatment supervisors include community or family members; Group C-drugs dispensed monthly and no supervised treatment. The cohort studied comprised all new patients starting treatment during a 5-month period in 1996 (n = 759).RESULTS:
At group A treatment centers, 100% of patients had daily DOT supervised by treatment center staff during the intensive phase. At group B sites, 75% of nominated supervisors were family or community members and 13% of patients had no supervisor. At group C sites 93% of patients were unsupervised. Bacteriologically confirmed cure rates for smear-positive patients were 91% (95%CI 80.3-97.2) for A sites, 57% (95%CI 48.8-64.0) for B, and 34% (95%CI 25.1-40.4) for C. Treatment centers with the best results had good access to laboratory facilities, uninterrupted drug supply, longer clinic hours, standardized TB case management, and support from a non-governmental organization.CONCLUSION:
At government facilities in Nepal, only group A treatment centers achieved World Health Organization global targets for cure. Group B treatment centers showed better outcomes than unsupervised therapy but did not achieve cure targets. Rapid low-cost assessments to collect data that are not routinely reported can improve the evaluation of program aspects such as supervision strategies.
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Base de dados:
MEDLINE
Assunto principal:
Tuberculose Pulmonar
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Adolescent
/
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2001
Tipo de documento:
Article