Comparative Assessment of TB Treatment Outcomes between Community-Based TB Care and Facility-Based Directly Observed Therapy of Tuberculosis Patients in the Upper West Region of Ghana

Abstract

Background: Tuberculosis as a public health threat is one of the main infectious diseases globally. Decentralization of DOT to Community-Based TB Care (CBTC) had improved TB treatment coverage and reduced health facilities burden. Provision of quality care and patients treatment monitoring is the basis to improve and increase success rates for treatment outcomes evaluation. The study assessed TB treatment outcomes between CBTC and FBDOT of TB patients in the Upper West Region. Methods: A retrospective review of TB patients treatment cards was conducted from 2015 to 2017. Data extracted were on patients demographic characteristics, TB classification, patient type, BMI, weight, district, HIV status and treatment strategies. A census of 1,076 patients data extracted was obtained. Proportions of patients under CBTC or FBDOT and their treatment outcomes were determined. The outcome of interest was treatment outcomes with indicators of treatment success (cured or completed) and adverse (died, failure, default, or transferred out) outcomes. Treatment outcomes of patients between CBTC vs FBDOT were compared using chi square test in STATA 15.0. Results: The study had 67.8% (730) males and 94.1% (1,012) adults while the modal age was (35-44 years). CBTC accounted for 83.6% (899) TB patients. Of the patients who received CBTC, 41.3% (371) were cured, 42.6% (383) completed treatment which accounted for 83.4% (754) treatment success, 10.7% (96) died, 2.0% (18) failed, 3.0% (27) defaulted and < 1% transferred out. Of the patients who received FBDOT, 30.5% (54) were cured, 54.2% (96) completed treatment which accounted for 16.6% (150) treatment success, 9.0% (16) died, 1.1% (2) failed, and 5.1% (9) defaulted. Chi-square revealed that patients treatment outcomes under CTBC vs FBDOT had no significant difference (p = 0.08). Conclusion: CBTC seems to have had higher treatment success rate compared to FBDOT but not significant so this requires further studies. Therefore, there is need for improvements in treatment monitoring, counselling, defaulter tracing and utilization of treatment supporters to enhance successful outcomes.