Tuberculosis patient care decentralised to district clinics with community-based directly observed treatment in a rural district of South Africa

SETTING: A rural district of the Northern Province, South Africa. OBJECTIVES: To measure the effect of decentralisation of a tuberculosis ser vice in a rural area on treatment outcomes. DESIGN: An intervention study that measured treatment outcomes of patients attending district clinics for tuberculosis treatment and compared these wi th outcomes of patients attending the district hospital. RESULTS: Over the ii-year period 1992-1995, 928 patients were admitted to t he tuberculosis unit of the district hospital. In the initial pre-intervent ion phase, the best estimate of completed treatment for all 503 cases was 6 1%, and for 206 new smear-positive patients it was 67%. The intervention pr ocess established a tuberculosis control programme with directly observed t reatment for all patients, and training and supervision of clinic staff. Ni nety per cent of all patients had community-based supporters. For most pati ents, cure was not proven, but assuming success from completion of and prov en adherence to treatment, successful outcomes for new smear-positive cases rose to 82% for decentralised (clinic) treatment, and 88% for those patien ts who lived in the district but attended the hospital for treatment. CONCLUSIONS: These findings suggest that district clinics can achieve the s ame good results as the hospital. It is recommended that tuberculosis contr ol needs a dedicated co-ordinator at district level to manage the necessary infrastructural and staff resources.