Lay health worker-supported tuberculosis treatment adherence in South Africa: an interrupted time-series study

SETTING: Better integration of treatment support for people living with tuberculosis (TB) and human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) is a challenge in many settings, and has been identified as a service priority. OBJECTIVE: To determine the impact, compared to directly observed therapy, of a TB treatment intervention modelled on the community antiretroviral treatment (ART) support programme in South Africa. DESIGN: An interrupted time-series design was used, including five intervention clinics and five comparison clinics. Data were collected from January 2005 to March 2008 and analysed using Poisson regression. RESULTS: Between April 2007 and March 2008, a total of 71% of all new TB patients starting treatment at the intervention clinics were placed on the intervention. There were no significant differences in cure or treatment success rates for new TB patients between intervention and comparison clinics. There was a small improvement in smear conversion rates in intervention clinics when compared to comparison clinics. CONCLUSION: The new model does not result in significantly different TB cure and treatment success rates, but does result in small improvements in smear conversion rates for smear-positive TB patients. The model holds potential for the better integration of TB and ART support.