Treatment outcomes of TB‐infected individuals attending public sector primary care clinics in rural Liberia from 2015 to 2017: a retrospective cohort study

• Published in: Tropical medicine & international health 2018-05, Vol.23 (5), p.549-557
• Main Authors: Wickett, Eugene, Peralta‐Santos, André, Beste, Jason, Micikas, Mary, Toe, Foriest, Rogers, Julia, Jabateh, Lassana, Wagenaar, Bradley H.
• Format: Article
• Language: English
• Subjects: aide aux ASC; aide socioéconomique; CHW assistance; Cohort analysis; Cohort Studies; Communicable Disease Control - organization & administration; Death; ebola; Ebola virus; Ebolavirus; Environment; Epidemics; Female; Health care; Health care facilities; Humans; Intervention; Liberia; Libéria; loss to follow‐up; Male; Medical personnel; Mortality; mortalité; Occupational health; Patient Compliance - statistics & numerical data; Patients; perte de suivi; Primary Health Care - methods; Public Sector; Ratios; Regression analysis; Retrospective Studies; Risk; Rural Population - statistics & numerical data; Smear; socio‐economic assistance; Statistical analysis; Transport; Treatment Outcome; tuberculose; Tuberculosis; Tuberculosis - therapy; Viral diseases; Viruses
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13049

Objectives In June 2015, Partners in Health (PIH) and the Liberian Ministry of Health began a community health worker (CHW) programme containing food support, reimbursement of transport and social assistance to address gaps in tuberculosis (TB) treatment exacerbated by the 2014‐2015 Ebola virus disease (EVD) epidemic. The purpose of this article was to analyse the performance of routine clinical TB care and the effects of this CHW programme. Methods Retrospective cohort study utilising data from TB patient registers at a census of all health facilities treating TB in the south‐east region of Liberia from January 2015 – April 2017. Competing risks Cox regression analyses were used to generate subhazard ratios (sHR) analysing factors associated with rates of TB cure (smear negative), treatment completion (no smear), lost to follow‐up (LTFU) and death. Results LTFU rates decreased 76% pre‐ vs. post‐CHW intervention, from 14.6% in pre‐intervention to 3.4% post‐intervention (P < 0.001). Although the post‐intervention had better cure rates (sHR 1.07, CI 0.58‐1.9), treatment completion (sHR 1.53, CI 1.00 2.39) and lower death rates (sHR 0.64, CI 0.34‐1.2), statistical significance was not reached. Younger patients had significantly lower death and cure rates, while older patients had higher LTFU and cure rates. Overall, 31% of patients were cured, 44% completed treatment without a confirmatory smear, 5% were LTFU, 9% died, 0.5% failed treatment, and 10% transferred out. Conclusions In challenging environments, LTFU can be reduced by CHW accompaniment and socio‐economic assistance to patients with TB. Approaches are needed to improve cure verification in young patients and reduce mortality. Objectifs En juin 2015, Partners in Health (PIH) et le ministère libérien de la Santé ont lancé un programme d'agents de santé communautaire (ASC), de soutien alimentaire, de remboursement des frais de transport et d'assistance sociale pour combler les lacunes dans le traitement de la tuberculose exacerbée par l’épidémie de 2014–2015 de la maladie de virus Ebola (EVD). Le but de cet article est d'analyser la performance des soins cliniques TB de routine et les effets de ce programme ASC. Méthodes Etude de cohorte rétrospective utilisant les données des registres des patients TB lors du recensement de tous les établissements de santé traitant la TB dans le sud‐est du Liberia de janvier 2015 à avril 2017. Des analyses de régression de Cox pour les risques ont été utilisées pour g