title: Task shifting for tuberculosis control: a qualitative study of community-based directly observed therapy in urban Uganda.
abstract: This qualitative study of task shifting examined tuberculosis (TB) therapy under modified community-based directly observed treatment short-course (CB-DOTS) in Kampala, Uganda. New TB patients selected one of two strategies: home-based DOTS and clinic-based DOTS. Relevant socio-economic characteristics, treatment-seeking experiences and outcomes were assessed over eight months of follow-up. Of 107 patients recruited, 89 (83%) selected home-based DOTS. Sixty-two patients (70%) under home-based DOTS and 16 patients (89%) under clinic-based DOTS had successful outcomes following completion of tuberculosis therapy. Treatment supporters' provision of social support beyond observing drug ingestion contributed to successful outcomes under both strategies. Home-based DOTS provides continuity of social support during therapy, strengthening the potential for treatment success. Conventional health facility-based DOTS can be modified in resource-limited urban Africa to offer a viable DOTS strategy that is sensitive to personal preference. Shifting the task of DOTS support away from only qualified health workers to include laypersons in the patients' social-support network may contribute to meeting World Health Organization (WHO) treatment targets. We recommend an intervention evaluating this modified DOTS strategy on a larger scale in TB high-burden, resource-poor urban settings.
authors.affiliation: Department of Social Work and Social Administration, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda. dmk28@case.edu
authors.forename: David K
authors.initials: DK
authors.lastname: Mafigiri
authors.forename: Janet W
authors.initials: JW
authors.lastname: McGrath
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
mesh_terms: D000293:Adolescent; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003153:Community Health Services; D023801:Directly Observed Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D060756:Social Networking; D012944:Social Support; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000517:prevention & control; D014454:Uganda; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents