Tuberculosis is a contagious disease which spreads infection through the air. When people whose lungs are infected with TB cough, sneeze, talk or spit, the TB germs, known as bacilli, spread through the air and infect others.
People already infected with the HIV virus are especially at risk of infection and death from TB, due to their compromised immune system. According to the World Health Organization (2009), TB kills more young people and adults than AIDS and Malaria combined. Additionally, one third of the world population is currently infected with TB.
Unfortunately, most countries in the world use only antibiotics to treat this disease. However, three intervention programmes have proved quite successful, one in Senegal, another by the World Health Organization, and another among inmates in San Francisco, California.
In Senegal, a randomized controlled trial, codenamed Programme Tuberculose, was carried out on 1522 patients with pulmonary TB (Medical News Today, 2007). The risk factor targeted was non adherence to treatment. Conducted in 16 government health centers between Jan 2003 and Jan 2005, the candidates selected were all 15 years or older, with 778 patients in the intervention group and 744 in the control group. In the intervention group, the patients were offered counseling, communication with health personnel and patients, decentralization of treatment and the supervision of treatment was reinforced. The control group was put on the normal TB program. During the period of the trial, it was discovered that patients in the intervention group responded more positively to treatment. They took their medication on aregular basis and their default rate was lower than that in the control group. The assessment of the study was that non-adherence was caused by many factors.
The chronic nature of the disease, poverty, poor interaction between health care workers and patients, all affect compliance and access to healthcare. A comprehensive intervention strategy based on sustainable activities aimed at patients, healthcare workers and communities, was thus seen as the best approach.
The World Health Organization, on the other hand, came up with a different strategy. The interrelationship between HIV and TB was the risk factor that they addressed. Targeting this particular group of patients, they realized that their intervention mechanism would have to be implemented with both these diseases in mind.
They therefore offered TB case detection and care among caregivers, prevented new cases of TB among HIV patients with isoniazid preventative treatment, and established mechanisms to coordinate home care programmes and TB clinics (World Health Organization, 2009). Additionally, they established programmes to increase community awareness of TB/HIV and their relationships.
In San Francisco, another interesting programme was put in place. Just like in Senegal, this study addressed the issue of adherence to treatment, in this case, by newly released prisoners. In this trial, the study group was composed of inmates in a San Francisco jail.
According to CAT.INST (2009), this particular group of inmates was divided in three. The first group, the intervention group, received an education every two weeks while in jail, the second was offered an incentive if they went to San Francisco County TB clinic within one month of release, while the third, the control group, was given the usual TB care.
The results from this study showed that the education and incentive group were more likely to visit the clinic within one month after release, and the education group was most likely to complete therapy. It was therefore determined that education is important in the treatment of TB.
In all three intervention scenarios, some issues stand out in the success or failure of treatment. Secondary intervention was used in all three trials, but the three strategies differed, if only slightly. In Senegal, the thrust of intervention was awareness and communication.
This may have been the best approach because, in Africa, health care workers can be intimidating, and poverty often leads to non adherence due to transportation problems and ignorance. On the other hand, the World Health Organization used what can be referred to as “killing two birds with one stone”.
They realized the interrelationship between HIV and TB, and developed a strategy that would offer a solution for TB cases, while at the same time, treating HIV. And in San Francisco, they used education as a tool to raise the self esteem of inmates suffering from TB, and thereby increased their likelihood of seeking treatment.
TB, like many other diseases, is dangerous. The solution for reducing infection or even managing the disease is different depending on the target group. Awareness of the risks and better communication with health workers is essential for the poor. Those in developed countries but lack an education must be enabled, and those in high risk groups like HIV patients, must be given high priority in treatment and coping mechanisms.