CHAPTER II - HEALTH SERVICES <<Back
 
b) Community Participation & Role of Voluntary Organizations
 
148
AU : Dick J, Schoeman JH, Mohammed A & Lombard C
TI : Tuberculosis in the community: 1.Evaluation of a volunteer health worker programme to enhance adherence to anti-tuberculosis treatment
SO : TUBERCLE & LUNG DIS 1996, 77, 274-79
DT : Per
AB :

A voluntary health worker project (Operation Elsies River) was started in a high incidence TB area in the Western Cape of South Africa, in order to assist the local TB control programme with case-holding. The objective is to evaluate the effectiveness of this group of volunteers in enhancing adherence of notified TB patients to TB treatment. A cohort study was conducted with 351 TB patients (203 children and 148 adults). The data from the child and the adult groups were analysed separately. The child group was more adherent to TB treatment than adults. The supervision option with staff dedicated to the treatment of TB, such as the clinic and the SANTA creche, achieved better adherence results for pre-school children. The supervision modalities for adults did not differ in their adherence performance even following adjustment for confounders.

The supervision option provided by the volunteers did not significantly improve the adherence of adult patients to anti-TB treatment.

KEY WORDS: COMPLIANCE; ADHERENCE; HEALTH WORKER; VOLUNTARY ORGANIZATION; SOUTH AFRICA

149
AU : Dick J & Schoeman JH
TI : Tuberculosis in the community: 2. The perceptions of members of a tuberculosis health team toward a voluntary health worker programme
SO : TUBERCLE & LUNG DIS 1996, 77, 380-83
DT : Per
AB :

The setting is a voluntary health worker programme, in the Western Cape South Africa, utilizing volunteers to administer directly observed therapy to TB patients. This study describes the perceptions of health team members regarding the voluntary community health worker project. A qualitative, participatory research study utilizing focus groups.

TB was perceived by the health team to be a stigmatized disease causing some patients to be reluctant to be associated with the TB control programme. Despite the project’s dedicated approach to case-holding volunteers expressed the need to develop skills in providing more comprehensive care. The volunteers appear to administer a more personalized service to TB patients and can bridge the gap between TB patients and the health agency. Sustained evaluation and support seem to be a vital tool in integrating a volunteer project into a health team approach. Its effectiveness appears to depend to a large degree on the people involved.

KEY WORDS: VOLUNTARY ORGANIZATION; SOCIAL AWARENESS; HEALTH TEAM; HEALTH WORKER; SOUTH AFRICA.
 

 
     CHAPTER IV - TREATMENT BEHAVIOUR OF TB PATIENTS  
 
a) Treatment Failure & The Problem of Non Adherence
 
228
AU : Dick J & Schoeman JH
TI : Tuberculosis in the community: 2. The perceptions of members of a tuberculosis health team toward a voluntary health worker programme
SO : TUBERCLE & LUNG DIS 1996, 77, 380-83
DT : Per
AB :

The setting is a voluntary health worker programme, in the Western Cape South Africa, utilizing volunteers to administer DOT to TB patients. This study describes the perceptions of health team members regarding the voluntary community health worker project. A qualitative, participatory research study utilizing focus groups. TB was perceived by the health team to be a stigmatized disease causing some patients to be reluctant to be associated with the TB control programme. Despite the project’s dedicated approach to case-holding volunteers expressed the need to develop skills in providing more comprehensive care. The volunteers appear to administer a more personalized service to TB patients and can bridge the gap between TB patients and the health agency. Sustained evaluation and support seem to be a vital tool in integrating a volunteer project into a health team approach. Its effectiveness appears to depend to a large degree on the people involved.

KEY WORDS: VOLUNTARY ORGANIZATION; SOCIAL AWARENESS; HEALTH TEAM; AFRICA.
 
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  b) Measures to Improve Treatment Adherence  
 
263
AU : Dick J & Lombard C
TI : Shared vision - a health education project designed to enhance adherence to anti-tuberculosis treatment
SO : INT J TB & LUNG DIS 1997, 1, 181-86
DT : Per
AB :

Two adjacent Cape Town Local Authority health clinics in Cape Town, South Africa, were selected. Clinic A was designated the "intervention clinic" and Clinic B the ‘control clinic’. To asses whether the combined strategy of a patient-centred interview plus the issuing of a patient education booklet would have the effect of increasing the adherence of notified pulmonary TB patients to prescribed treatment.

A controlled intervention study was implemented using a cohort of the first 60 consecutive patients notified with pulmonary TB at both Clinic A and Clinic B; the patient cohort thus consisted of 120 patients. The risk of patient non-adherence to anti-TB treatment was significantly reduced at the intervention clinic compared to the control clinic.

The results of this study indicate the need for further operational research to assist health providers in developing standardised protocols of health education to enhance adherence to treatment in patients who require protracted treatment regimens.

KEY WORDS: SOCIAL COST; COMPLIANCE; HEALTH EDUCATION; AFRICA.
 
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