Mapping the effectiveness of the community TB care programme: A systematic review

BackgroundTuberculosis (TB) is a major public health problem throughout the world particularly in resource limited countries. In light of the global urgency to improve TB care, the World Health Organisation emphasize the importance of taking into consideration the journey of a TB patient through a series of interlinked settings and facilities. One of these is decentralising TB care beyond health facilities and harness the contribution of communities through provision of effective community-based directly observed therapy (DOT) to TB patients at greatest socio-economic risk. A systematic review was conducted to map previously conducted studies to identify existing community TB implementation models, their effectiveness on cost and treatment outcomes. MethodsSystematic search through various electronic databases electronic databases; Medline/PubMed, EBSCO (PsycINFO and CINAHL) and Cochrane libraries was performed between the year 2000 and 2021. We used the following free text search terms Tuberculosis, Community tuberculosis, cost effectiveness and treatment outcomes for this purpose. Their quality was scored by ROBINS-I and ROB 2. ResultsA total of 6982 articles were identified with 36 meeting the eligibility criteria for analysis. Two observational studies in low-and middle-income countries reported comparable video observed treatment completion rates to in-person directly observed therapy (0.99-1.47(95% CI 0.93-2,25) with one randomised control trial in a high-income country reporting an increased video observed treatment success rate to standard care (OR 2.52, 95% CI 1.17-5.47). An incremental cost saving ranged was $1391-$2226. Electronic medication monitors increased the probability of treatment success rate (RR 1.0-4.33 and the 95% CI 0.98-95.4) in four cohort studies in low-and middle-income countries with incremental cost effectiveness of $434. Four cohort studies evaluating community health worker direct observation therapy in low-and middle-income countries showed treatment success risk ratio ranging between 0.29-3.09 with 95% CI 0.06-7.88. (32,41,43,48) with incremental cost effectiveness up to USS$410 while four randomised control trials in low-and middle-income countries reported family directly observed treatment success odds ratios ranging 1.03-1.10 95% CI 0.41-1.72. Moreover, four comparative studies in low-and middle-income countries showed family directly observed treatment success risk ratio ranging 0.94-9.07, 95% CI 0.92-89.9. Lastly four Short Message Service trials revealed a treatment success risk ratio ranging 1.0-1.45, 95% CI fell within these values) with cost effectiveness of up to 350I$ compared to standard of care. ConclusionsThis review illustrates that community-based TB interventions such as video observed therapy, electronic medication monitors, community health worker direct observation therapy, family directly observed treatment and short Message Service can substantially bolster efficiency and convenience for patients and providers thus saving costs and improving clinical outcomes.