title: Self-administered treatment for tuberculosis among pastoralists in rural Ethiopia: how well does it work?
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Médecins sans Frontières, Medical Department (Operational Research Unit/Operations), Brussels Operational Centre, MSF-Luxembourg, Luxembourg mohammed.khogali@gmail.com.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khogali
authors.affiliation: Médecins sans Frontières, Medical Department (Operational Research Unit/Operations), Brussels Operational Centre, MSF-Luxembourg, Luxembourg.
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: Médecins sans Frontières, Medical Department (Operational Research Unit/Operations), Brussels Operational Centre, MSF-Luxembourg, Luxembourg.
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
authors.affiliation: Médecins sans Frontières, Addis Ababa, Ethiopia.
authors.forename: Sweet C
authors.initials: SC
authors.lastname: Alipon
authors.affiliation: Médecins sans Frontières, Addis Ababa, Ethiopia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Zimble
authors.affiliation: Médecins sans Frontières, Addis Ababa, Ethiopia.
authors.forename: Gbane
authors.initials: G
authors.lastname: Mahama
authors.affiliation: Médecins sans Frontières, Operational Centre Brussels, Brussels, Belgium.
authors.forename: William
authors.initials: W
authors.lastname: Etienne
authors.affiliation: Médecins sans Frontières, Operational Centre Brussels, Brussels, Belgium.
authors.forename: Richard
authors.initials: R
authors.lastname: Veerman
authors.affiliation: Médecins sans Frontières, Medical Department (Operational Research Unit/Operations), Brussels Operational Centre, MSF-Luxembourg, Luxembourg.
authors.forename: Amine
authors.initials: A
authors.lastname: Dahmane
authors.affiliation: Ministry of Health, Jijiga, Ethiopia.
authors.forename: Tadiwos
authors.initials: T
authors.lastname: Weyeyso
authors.affiliation: Médecins sans Frontières, Addis Ababa, Ethiopia.
authors.forename: Abdu
authors.initials: A
authors.lastname: Hassan
authors.affiliation: International Union against Tuberculosis and Lung Disease, Paris, France London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Harries
mesh_terms: D000293:Adolescent; D000328:Adult; D000383:Agriculture; D000822:Animal Husbandry; D015331:Cohort Studies; D005002:Ethiopia / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D012648:Self Care; D014171:Transients and Migrants; D014376:Tuberculosis / Q000188:drug therapy* / Q000401:mortality; D055815:Young Adult; D016903:Drug Monitoring
keywords: Ethiopia; Operational research; Pastoralists; SAT; Tuberculosis