The global tuberculosis epidemic is being fuelled by dual infection with human immunodeficiency virus type I. Short-course chemotherapy is effective but usually fails for operational reasons. A community-based treatment programme of twice-weekly fully-supervised treatment is described in which 89% of surviving patients completed treatment under programme conditions. Half the patients were successfully supervised by non-health workers. New approaches are needed to combat the global tuberculosis epidemic.
PIP: This article describes a tuberculosis (TB) treatment program which achieved a high rate of compliance and completion by close supervision in a supervised intermittent ambulatory treatment (SIAT) program in Zululand, South Africa. After patients had reported to a hospital for sickness and were subsequently diagnosed positive for TB, they were aligned with a SIAT center and a TB treatment site was selected. In most cases these assignments were chosen by the patient as a matter of personal convenience. In 1993, 36% of the adults diagnosed with TB were also infected with human immunodeficiency virus type 1 (HIV-1). Supervisors were selected to oversee each treatment site and were given responsibility for ensuring that patients took their medication. Supervisors also kept treatment records which were inspected by trained medical personnel. In cases where patients missed treatment appointments, the trained medical personnel would investigate. The SIAT program included a 6-month chemotherapy treatment procedure conducted at supervised sites which included hospital-run clinics and non-hospital operated health care sites. The author reports that a full and complete course of chemotherapy is a critical aspect in the management of TB. He reports that the SIAT program ensures a high compliance rate and that a high completion-of-treatment rate (60% vs. 18% pre-SIAT) is possible when using a community-based SIAT program against TB.