By Wallace Mawire
New research finds that a community-based approach to delivering TB treatment is highly effective at achieving successful TB treatment outcomes in Togo.
The Union led the study in partnership with Togo’s National TB Programme (NTP) and the World Health Organization’s Special Programme for Research and Training in Tropical Diseases.
The researchers found that 93% of participants had favourable outcomes after six months (e.g. cured and/or completed treatment) through a community health worker-led approach to supervising treatment intake, compared to 78% through a family member supervising treatment intake.
From April 2021 to January 2022, the study team evaluated two innovative approaches to directly observed treatment (DOT) – a community health worker-based (CHW-DOT) and family-based (FB-DOT) approach. The study specifically assessed the sputum smears conversions (i.e. when a positive sputum culture becomes negative after treatment) at month two and favourable treatment outcomes at month six, and identified factors relating to these outcomes.
The CHW-DOT approach also had a significantly higher rate of sputum smears conversions after two months, 92% of participants, compared to 74% through the FB-DOT approach.
In addition, the study found that smoking had a significantly negative impact on treatment outcomes for both treatment approaches. Only 52% of tobacco users achieving smear conversions at month two, compared to 89% of non-smokers. While approximately one-in-two smokers had unfavourable treatment outcomes (48%), just 8% of non-smokers had unsuccessful outcomes.
The research paper was recently published in the International Journal of Tuberculosis and Lung Disease.
Dr Kobto Koura, Director of TB at The Union, said: “These results provide us with vital insight into the most effective mechanism for delivering TB treatment at a community level in Togo, which will enable the NTP to make more informed decisions about how to support people with TB.
“The use of tobacco, significantly associated with outcomes, also suggests that a smoking cessation component may be a valuable addition to community-based TB treatment.”
“In addition to the results, the project has demonstrated two important elements. The first is the real-time adaptability of African NTP, and the second is that the community should be involved in NTP activities and can improve results.”
“We thank people with TB and colleagues for their involved in this project.”
The project was performed in eight TB clinics within high TB burden regions, of which four implemented CHW-DOT and four implemented FB-DOT.
Despite progress in TB control, it remains a public health challenge in Togo, with the estimated incidence of TB being 33 cases per 100,000 people and TB mortality (all forms, excluding HIV-positive TB patients) at 2.7 deaths per 100,000 people in 2021.
Established in 1920, the International Union Against Tuberculosis and Lung Disease (The Union) is committed to creating a healthier world for all, free of tuberculosis and lung disease.
The Union is the world’s first global health organisation and a global leader in ending TB. Its members, staff, and consultants work in more than 140 countries.
The Union strives to end suffering due to tuberculosis and lung diseases, old and new, by advancing better prevention and care. It seeks to achieve this by the generation, dissemination, and implementation of knowledge into policy and practice.
The Union aims to ensure that no one is left behind, people are treated equally and we have a focus on vulnerable and marginalised populations and communities.
