Abstract:
Introduction Tuberculosis (TB) causes approximately 2 million deaths every year. The problem is escalating explosively in sub-Saharan Africa and is directly related to the increase in the prevalence ofHuman Immunodeficiency Virus infection. South Africa was ranked as having the fourth highest global incidence of TB in 2006. In 1993, the World Health Organization introduced the Directly Observed Treatment Short-Course strategy to increase efficiency of national TB programmes. The Direct Observation of TB therapy element of the strategy has been contentious. An ideal method of direct observation remains elusive and its role in improving adherence is questionable. Aim The purpose ofthis research is to detennine the most effective directly observed method for pulmonary TB offered in an urban area of South Africa. Methods A retrospective cohort analysis was conducted at the Prince Cyril Zulu Communicable Diseases Centre in Durban, KwaZulu-Natal. The study population consisted of adult patients who commenced a course of TB therapy between July 2005 and June 2006. The effect of clinic based, family member, community health worker, lay community health volunteer and workplace based direct observation on TB treatment outcomes, and frequency of recurrence was detennined. A sub analysis was perfonned of the effect of the different methods ofdirect observation in employed patients. Results Workplace based direct observation resulted in a higher frequency of successful treatment outcomes than the other methods of Direct Observation. Being a re treatment patient was the only significant factor associated with recurrence, both for the entire study population and for those who were employed. Discussion The findings of this study are generalizable to other developing countries where challenges in implementation ofan effective TB programme such as poverty, high burden of HIV infection, a migrant population with strong rural ties and reliance on traditional practices to cure illness play a major role. Recommendations There is often no best treatment observer. Every case has to be individually evaluated and the most acceptable and accessible treatment observer chosen. The findings ofthis study strongly suggest that workplace Direct Obse ation can have a significant impact in improving TB treatment outcomes.
