Some years ago we did two trials [1 2] to improve case finding of tuberculosis in South Ethiopia. Our study from Sidama in South Ethiopia showed that involving Health Extension workers in Tuberculosis control improved the case detection (from 69 to 122 %) for smear-positive patients and females in particular [1]. We advised that this intervention could be used as an option to improve case detection and provide patient-centred services in high-burden countries. In a later study, we showed that this intervention is a cost-effective treatment alternative to the health service and to the patients and their caregivers [3].
We advised there is both an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia.
Now a large consortium (Stop TB Partnership’s TB REACH initiative and implemented by the Southern Region Health Bureau and the Liverpool school of Tropical Medicine in collaboration with the Ministry of Health and the Global Fund) has scaled up this intervention in Sidama [4]. Their findings are similar to our earlier research: “Community-based interventions made TB diagnostic and treatment services more accessible to the poor, women, elderly and children, doubling the notification rate (from 64 to 127%) and improving treatment result. They advise that this approach could improve TB diagnosis and treatment in other high burden settings”.
I hope that they also present some findings on how this good intervention can be made sustainable in settings such as Sidama.
References
1. Datiko DG, Lindtjørn B. Health extension workers improve tuberculosis case detection and treatment success in southern Ethiopia: a community randomized trial. PLoS One 2009;4(5):e5443 doi: 10.1371/journal.pone.0005443[published Online First: Epub Date]|.
2. Shargie EB, Morkve O, Lindtjorn B. Tuberculosis case-finding through a village outreach programme in a rural setting in southern Ethiopia: community randomized trial. Bull World Health Organ 2006;84(2):112-9
3. Datiko DG, Lindtjorn B. Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial. PLoS One 2010;5(2):e9158 doi: 10.1371/journal.pone.0009158[published Online First: Epub Date]|.
4. Yassin MA, Datiko DG, Tulloch O, et al. Innovative Community-Based Approaches Doubled Tuberculosis Case Notification and Improve Treatment Outcome in Southern Ethiopia. PLoS ONE 2013;8(5):e63174 doi: 10.1371/journal.pone.0063174[published Online First: Epub Date]|.