Integration of tuberculosis treatment in a community-based home care programme for persons living with HIV/AIDS in Ndola, Zambia.

Setting: Two small urban townships (compounds) in Ndola, Zambia, served by an HIV/AIDS home care programme.

Objective: To evaluate the implementation of the directly observed treatment, short-course (DOTS) strategy as part of an existing HIV/AIDS home care programme, by comparing TB treatment outcomes in an intervention population (Chipulukusu compound), where implementation of the DOTS strategy is an integral part of the HIV/AIDS home care programme, and in a control population (Twapia compound) with district TB services but as yet without coverage by the HIV/AIDS home care programme.

Design: Prospective evaluation of all new sputum smear-positive TB patients registered in Chipulukusu and Twapia compounds between 1 February 1998 and 30 September 1999, with documentation of 2-month sputum smear conversion and 8-month treatment outcomes.

Results: There were 72 new sputum smear-positive pulmonary TB cases in Chipulukusu and 96 in Twapia registered during the study period. In comparing treatment outcomes in Chipulukusu and Twapia, there was no significant difference in treatment success (cure plus treatment completion) (61% vs. 48.9%) or in deaths (22% vs. 19%). However, cure rate was significantly higher in Chipulukusu than in Twapia (54.2% vs. 20.8%) and treatment interruption was significantly lower in Chipulukusu than in Twapia (8.3% vs. 22.9%).

Conclusion: Integration of the DOTS strategy for TB control with an existing HIV/AIDS home care programme led to improved TB programme performance in a compound with a small population (about 20000). There is scope to scale up this approach so that the entire population of all the compounds in Ndola served by the HIV/AIDS home care programme can benefit from improved TB control.