TUBERCULOSIS CARE IN COMMUNITY CARE ORGANIZATIONS IN SUB-SAHARAN AFRICA - PRACTICE AND POTENTIAL

SETTING: Community care organizations in sub-Saharan Africa. OBJECTIVE S: To evaluate current tuberculosis (TB) care in community health care organizations in sub-Saharan Africa, to assess their potential contri bution to tuberculosis care, and to develop a model for expanded commu nity participation in effective TB control. DESIGN: Quantitative asses sment of tuberculosis care and cross-sectional assessment of qualitati ve measures in 14 community care organizations in Uganda, Zambia, Sout h Africa and Malawi. RESULTS: The community care organizations assesse d mainly provided care for human immunodeficiency virus (HIV) and aqui red immune deficiency syndrome (AIDS) patients, and received funding f rom non-governmental organizations. Shortcomings in tuberculosis care included delays in diagnosis (which was often not based on sputum exam ination), drug shortages, low completion rates, high default rates, in adequate recording, little interaction with government tuberculosis pr ogrammes, and inadequate training of staff. However, one organization that provided primarily tuberculosis care and collaborated closely wit h the district tuberculosis programme and hospital attained a high tre atment completion rate. The strong points of the community care organi zations that favour a potential role of community participation in tub erculosis care were accessibility and staff motivation. CONCLUSION: De spite most community care organizations' shortcomings in tuberculosis care, they do have the potential to improve the care of tuberculosis p atients, thus reducing the load on overstretched health facilities. Th eir potential impact on tuberculosis control depends on their populati on coverage and sustainability. HIV/AIDS community care organizations with strengthened management of tuberculosis care could serve as a mod el for expanded community participation in tuberculosis control. Opera tional research is needed to assess the feasibility and cost-effective ness of community-based TB care.