The role of the community in the control of tuberculosis.

SETTING

High tuberculosis (TB) prevalence countries, where National TB programmes (NTPs) need to ensure widespread access to effective treatment.

OBJECTIVE

To review possible ways in which communities can contribute to TB control and to describe the project "Community TB Care in Africa".

DESIGN

A review of the literature on community contribution to TB control and a progress report on the project "Community TB Care in Africa".

RESULTS

Eight district-based projects in six countries (Botswana, Kenya, Malawi, South Africa, Uganda, Zambia) participated in the overall "Community TB Care in Africa" project. District TB programmes offering patients the choice of community or health facility treatment supervision generally performed effectively, with satisfactory rates of treatment success. Average health system and patient and family costs were lower in comparison with controls.

CONCLUSION

Investigators formulated policy recommendations. NTPs should: (1) extend TB care to the community to improve access; (2) identify suitable community TB treatment supporters in consultation with the community; (3) ensure that effective systems extend into the community for recording and reporting, and for supply of anti-TB drugs; (4) monitor community contribution to TB care using standard indicators; (5) develop costed plans for expansion of the community approach. Ministries of Health should: (1) ensure adequate financing; (2) coordinate the efforts of NTPs, donors and NGOs to ensure sustainability; (3) consider opportunities for collaboration between NTPs and HIV/AIDS programmes.