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Assessment of patient preference in allocation and observation of anti-tuberculosis medication in three districts in Tanzania

Authors Saidi Egwaga, Nyagosya Range, Fred Lwilla, Abdallah Mkopi, Vivien Barongo, et al

Published 5 February 2008 Volume 2008:2 Pages 1—6

Saidi Egwaga1, Nyagosya Range2, Fred Lwilla1, Abdallah Mkopi4, Vivien Barongo2, Sally Mtenga3, Hassan Mshinda3, Frank Cobelens4,5, Vera Haag6, Frank van Leth4,5, Penny Grewal6

1National Tuberculosis and Leprosy Programme, Ministry of Health and Social Welfare, Dar es Salaam,Tanzania; 2National Institute for Medical Research, Dar es Salaam,Tanzania; 3Ifakara Health Research and Development Centre, Ifakara, Tanzania; 4KNCV Tuberculosis Foundation, The Hague, The Netherlands; 5Center for Infection and Immunity, Academic Medical Center, University of Amsterdam, The Netherlands; 6Novartis Foundation for Sustainable  Development, Basle, Switzerland

Background: The new tuberculosis (TB) treatment in Tanzania contains rifampicin for six months. Direct observation of drug intake at the health facility for this period is not feasible.

Methods: Patients and health staff in three districts were interviewed to assess the burden of the current treatment strategy, and opinions on a proposed new strategy where patients are able to choose the place of treatment and the treatment supervisor, and receive treatment as a daily combination tablet.

Results: The study included 343 patients in 42 facilities. Daily collection of drugs was perceived as burdensome irrespective of distance needed to travel. Eighty percent of patients viewed medication taken at home or at a closer health facility as an improvement in TB-services. The proposed new treatment strategy was rated favorably by 85% of patients and 75% of health staff. Fifty-three percent of patients would opt for home-based treatment, and 75% would choose a family member or the spouse as treatment supporter.

Conclusion: Home-based supervision of TB treatment with fewer drugs is an expressed preference of TB patients in Tanzania. Such a strategy is now being assessed in a pilot study. If effective and feasible, the strategy will contribute to an improved TB control strategy.