Does the type of treatment supporter influence tuberculosis treatment outcomes in Zimbabwe? [Short communication]

Abstract

Zimbabwe is one of the world’s 22 high tuberculosis(TB) burden countries, and ⩾60% of its TB patients are infected with the human immunodeficiency virus (HIV).1 In 2010, the treatment success rate for new sputum smear-positive TB patients was 81%, lower than the 90% rate recommended by the new Global Plan to Stop TB.The World Health Organization’s (WHO’s) Stop TB strategy recommends supervised treatment and support,including direct observation of treatment (DOT), ensuring that every dose of medication is swallowed under observation. The Zimbabwean National TB Guidelines recommend that DOT should be provided, in order of priority, by a health facility-based worker, a trained community worker or a family member/relative as a last resort, with the belief that untrained family members/relatives might not be the best people to perform DOT. However, health facility-based DOT may be challenging due to distances travelled by patients,time spent away from home/work and transport costs.Studies in Thailand, Nepal, Malawi and Tanzania have shown that family- or community-based DOT is associated with good treatment outcomes.There is no published information on whether TB treatment outcomes are infl uenced by different types of DOT supporter in Zimbabwe. We therefore conducted this study in a district of Zimbabwe to describe 1) the number and proportions of registered TB patients receiving different types of DOT in relation to baseline characteristics and 2) the association of different types of DOT with TB treatment outcomes.