title: Treatment supporters and their impact on treatment outcomes in routine tuberculosis program conditions in rawalpindi district, pakistan.
abstract: BACKGROUND
  Tuberculosis (TB) is a major cause of mortality affecting millions of people in third world countries. In DOTS monitoring of patients is facility-based and treatment supporter-based; by these two ways patients' compliance to treatment is monitored. The aim of this study was to evaluate the role of treatment supporters and their impact on patients' treatment outcomes.
  
  
  METHODS
  The study was a cross-sectional survey in the routine TB control program operational context. All sputum smear positive TB patients that were diagnosed and registered by the public sector in the urban and rural diagnostic centers in 2008 with available outcomes were included in the study. Data of 451 patients were collected during August-October 2010 from 15 health facilities.
  
  
  RESULTS
  The majority of patients (89.6%) were provided with treatment supporters. Of 404 (89.6%) cases with treatment supporters, in 203 (50.2%) the supporters were lady health workers, in 46 (11.4%) were community health workers and health facility workers, and in 155 (38.4%) were family members and community volunteers. A total of 384 (85.1%) were categorized as "treatment success", 31 (6.9%), as "transferred out", 17 (3.8%), as "expired", 16 (3.5%) as "defaulted" and three (0.7%) as "treatment failure". The treatment success rates in patients supervised by Lady health workers, community health workers and health facility workers, and family members and community volunteers were 93.1%, 89.1% and 73.5%, respectively.
  
  
  CONCLUSIONS
  We found a significantly higher treatment success rate (93.1%) in patients supervised by lady health workers compared to others. The overall treatment success rate was 85.1%.
authors.affiliation: Department of Community Medicine, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan ; Centre for International Health, University of Bergen, Norway.
authors.forename: Munawar Hussain
authors.initials: MH
authors.lastname: Soomro
authors.affiliation: National TB Control Program, Pakistan.
authors.forename: Ejaz
authors.initials: E
authors.lastname: Qadeer
authors.affiliation: Association for Social Development, Pakistan.
authors.forename: Muhammad Amir
authors.initials: MA
authors.lastname: Khan
authors.affiliation: Centre for International Health, University of Bergen, Norway.
authors.forename: Odd
authors.initials: O
authors.lastname: Morkve
keywords: Outcomes; Pakistan; Treatment supporter; Tuberculosis