Differentiated service delivery for TB treatment

Area of Science:

• Public Health
• Infectious Disease Management
• Health Services Research

Background:

• Differentiated service delivery (DSD) models integrate decentralization, multi-month medication dispensing, and patient support for tuberculosis (TB) treatment.
• This study evaluates the characteristics and outcomes of TB patients managed under a DSD model in Zambia.

Purpose of the Study:

• To describe patient demographics, clinical profiles, and treatment support mechanisms within a TB treatment DSD model.
• To assess the treatment success rates and identify factors associated with successful TB treatment outcomes.

Main Methods:

• A cohort of 970 TB patients across five facilities in Lusaka and Livingstone, Zambia, were analyzed from February 2022 to March 2023.
• Medicines were dispensed for 2-month intensive and 4-month continuation phases, with support via text, phone, and home visits.
• Statistical analysis (Pearson's χ² or Fisher's exact tests) examined associations between patient characteristics, support, and treatment success.

Main Results:

• The majority of patients were HIV-negative (72%) and had pulmonary TB (94%).
• While text-based support had low engagement (6%), phone/home visits reached 85% of patients.
• An overall TB treatment success rate of 83% was achieved, with variations by facility and TB type. Patients receiving any treatment support showed higher success rates (85% vs. 76%).

Conclusions:

• Differentiated service delivery models, particularly those incorporating robust treatment support, are effective in achieving high TB treatment success rates.
• These models empower patients by offering greater control over their care, potentially enhancing adherence and outcomes.
• Optimizing patient support strategies within DSD frameworks is crucial for improving tuberculosis management.