Mohammed Khogali1, Rony Zachariah2, Tony Reid2, Sweet C Alipon3, Stuart Zimble3, Gbane Mahama3, William Etienne4, Richard Veerman4, Amine Dahmane2, Tadiwos Weyeyso5, Abdu Hassan3, Anthony Harries6. 1. Médecins sans Frontières, Medical Department (Operational Research Unit/Operations), Brussels Operational Centre, MSF-Luxembourg, Luxembourg mohammed.khogali@gmail.com. 2. Médecins sans Frontières, Medical Department (Operational Research Unit/Operations), Brussels Operational Centre, MSF-Luxembourg, Luxembourg. 3. Médecins sans Frontières, Addis Ababa, Ethiopia. 4. Médecins sans Frontières, Operational Centre Brussels, Brussels, Belgium. 5. Ministry of Health, Jijiga, Ethiopia. 6. International Union against Tuberculosis and Lung Disease, Paris, France London School of Hygiene and Tropical Medicine, London, UK.
Abstract
OBJECTIVES: In the Somali Regional State, Ethiopia, where most of the population are pastoralists, conventional TB treatment strategies based on directly observed treatment (DOT) at health facilities are not adapted to the mobile pastoralist lifestyle and treatment adherence is poor. From a rural district, we report on treatment outcomes of a modified self-administered treatment (SAT) strategy for pastoralists with TB. METHODS: A descriptive cohort study was carried out between May 2010 and March 2012. The modified DOT strategy comprised a shorter intensive phase at the health facility (2 weeks for new patients, 8 weeks in the event of re-treatment), followed by self-administered TB treatment. RESULTS: A total of 390 patients started TB treatment. The overall treatment success rate was 81.2% (317/390); the rates of death, loss-to-follow up and treatment failure were 6.7% (26/390), 9.2% (36/390) and 0.3% (1/390) respectively. A considerable proportion (10/26, 38%) of deaths occurred during the first month of treatment. CONCLUSION: In a pastoralist setting, a modified SAT strategy resulted in good treatment outcomes. If the global plan to eliminate TB by 2050 is to become a reality, it will be necessary to adapt TB services to client needs to ensure that all TB patients (including pastoralists) have access to TB treatment.
OBJECTIVES: In the Somali Regional State, Ethiopia, where most of the population are pastoralists, conventional TB treatment strategies based on directly observed treatment (DOT) at health facilities are not adapted to the mobile pastoralist lifestyle and treatment adherence is poor. From a rural district, we report on treatment outcomes of a modified self-administered treatment (SAT) strategy for pastoralists with TB. METHODS: A descriptive cohort study was carried out between May 2010 and March 2012. The modified DOT strategy comprised a shorter intensive phase at the health facility (2 weeks for new patients, 8 weeks in the event of re-treatment), followed by self-administered TB treatment. RESULTS: A total of 390 patients started TB treatment. The overall treatment success rate was 81.2% (317/390); the rates of death, loss-to-follow up and treatment failure were 6.7% (26/390), 9.2% (36/390) and 0.3% (1/390) respectively. A considerable proportion (10/26, 38%) of deaths occurred during the first month of treatment. CONCLUSION: In a pastoralist setting, a modified SAT strategy resulted in good treatment outcomes. If the global plan to eliminate TB by 2050 is to become a reality, it will be necessary to adapt TB services to client needs to ensure that all TBpatients (including pastoralists) have access to TB treatment.