Patient satisfaction with directly observed treatment and multidrug-resistant tuberculosis injection administration by lay health workers in rural Eswatini

Background: The human resources for health crisis in rural Eswatini led to a novel community-based multidrug-resistant tuberculosis (MDR-TB) treatment strategy based on task-shifting, that is delegation of directly observed treatment (DOT) and administration of MDR-TB injections, traditionally restricted to professional nurses, to lay community treatment supporters (CTSs). Aim: This study assessed the level of patient satisfaction with receiving community-based MDR-TB care from a CTS. Setting: The study was conducted at three MDR-TB-treating facilities in the mostly rural Shiselweni region. Methods: A cross-sectional survey of a purposive sample of 78 patients receiving DOT and intramuscular MDR-TB injections from CTSs was carried out in 2017. Descriptive statistics and regressions were calculated. Results: A high overall general patient satisfaction score for receiving community-based MDR-TB care from a CTS was observed. Adherence counselling, confidentiality, provider selection and treatment costs significantly (p < 0.05) influenced satisfaction. A large majority (n = 62; 79.5%) of patients indicated that they would likely recommend their significant others to receive MDR-TB care from a CTS. Respondents identified the need to provide CTSs with adequate training, regular supervision and sufficient incentives and also to broaden the scope of their services. Conclusion: This study observed that task-shifting of DOT and MDR-TB injection administration to CTSs was supported from a patient perspective. However, adherence counselling, confidentiality, provider selection and treatment costs should be taken into account in community-based MDR-TB care programming. Further to the patients, community-based tuberculosis care could be enhanced by improving CTSs' training, supervision and incentives, and broadening the scope of their services

TB/HIV-Related Training; Knowledge and Attitudes of Community Health Workers in the Free State Province; South Africa

With its emphasis on task shifting and multi-trained and skilled outreach teams the primary healthcare (PHC) re-engineering strategy in South Africa depends on the training; knowledge and attitudes of community health workers (CHWs) to provide a variety of TB/HIV services. The aim of this exploratory research was to assess TB/ HIV-related training; knowledge and attitudes of CHWs. Interviews were conducted with 206 CHWs at 28 clinics in 1 urban and 2 rural sub-districts in the Free State province. Descriptive and bivariate analyses were performed using chi-square; Kruskal-Wallis (H) and Mann-Whitney (U) tests for non-parametric data. More than half (54.9) had not received basic training in HIV counselling and testing; almost one-third (31.1) had not received basic training in TB/directly observed treatment (DOT) support. Furthermore; most CHWs had not received any follow-up training in HIV counselling and testing and in TB/DOT support. Significant associations (0.01 p 0.05) between the types of CHWs and their sub-district location; and their TB/HIV-related training; knowledge and attitudes were observed. In respect of the TB/HIV knowledge items assessed; a large majority (95) were knowledgeable; with only a few being ignorant about important facts related to TB/HIV. Lay counsellors were significantly more knowledgeable about TB/HIV than TB/DOT supporters and other CHWs were. Most CHWs disagreed with stigmatising statements about people with TB/HIV. The sub-district location of CHWs was significantly associated with their attitudes towards people with TB/HIV. CHWs in the two rural sub-districts were more likely to agree with stigmatising statements. In the context of PHC re-engineering; this exploratory research suggests that CHW TB/HIV training; knowledge and attitudes can and need to be improved if integrated TB/HIV services are to be successfully task-shifted to them in line with policy recommendations.