Open Access Research article

Health workers’ performance in the implementation of Patient Centred Tuberculosis Treatment (PCT) strategy under programmatic conditions in Tanzania: a cross sectional study

Abdallah Mkopi1*, Nyagosya Range2, Mbaraka Amuri1, Eveline Geubbels1, Fred Lwilla1, Saidi Egwaga3, Alexander Schulze4 and Frank van Leth56

Author affiliations

1 Ifakara Health Institute, P.O. Box 78373, Dar es Salaam, Tanzania

2 National Institute for Medical Research, Dar es Salaam, Tanzania

3 National Tuberculosis and Leprosy Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania

4 Novartis Foundation for Sustainable Development, Basel, Switzerland

5 KNCV Tuberculosis Foundation, The Hague, The Netherlands

6 Department of Global Health, Academic Medical Centre, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands

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Citation and License

BMC Health Services Research 2013, 13:101  doi:10.1186/1472-6963-13-101

Published: 16 March 2013

Abstract

Background

Patient Centred Tuberculosis Treatment (PCT) is a promising treatment delivery strategy for Mycobacterium tuberculosis (TB). It aims to improve adherence to treatment by giving patients the choice of having drug intake supervised at the health facility by a medical professional or at home by a supporter of their choice.

Methods

A cross-sectional survey was undertaken in three districts of Tanzania during October 2007, one year after PCT was rolled out nationally. Semi-structured questionnaires were used to assess whether key elements of the PCT approach were being implemented, to evaluate supporters’ knowledge, to capture opinions on factors contributing to treatment completion, and to assess how treatment completion was measured. Transcripts from open-ended responses were analysed using framework analysis.

Results

Interviews were conducted with 127 TB patients, 107 treatment supporters and 70 health workers. In total, 25.2% of TB patients were not given a choice about the place of treatment by health workers, and only 13.7% of those given a choice reported that they were given adequate time to make their decision. Only 24.3% of treatment supporters confirmed that they were instructed how to complete patients’ treatment cards. Proper health education was the factor most frequently reported by health workers as favouring successful completion of TB treatment (45.7%). The majority of health workers (68.6%) said they checked returned blister packs to verify whether patients had taken their treatment, but only 20.0% checked patients’ treatment cards.

Conclusions

The provision of choice of treatment location, information on treatment, and guidance for treatment supporters need to be improved. There is a requirement for regular re-training of health workers with effective supportive supervision if successful implementation of the PCT approach is to be sustained.

Keywords:
TB; Directly observed treatment; PCT; Home-based; Patient centred treatment; Tanzania