Evaluation of community contribution to tuberculosis control in Cape Town, South Africa

SETTING: Low income, high density, urban settlements in Cape Town, South Africa. OBJECTIVES: To evaluate community treatment supervision as part of tuberculosis (TB) programme implementation. DESIGN : A non-randomised prospective study was conducted under programme conditions from January 1998 to December 1999, comparing TB programme performance in an area with (Guguletu), and an area without (Nyanga) the option of TB treatment supervision by community health workers. RESULTS: Data were collected for 2873 adult TB patients. For smear-positive TB patients, treatment cure rates were higher in the intervention area (Guguletu) than in the control area (Nyanga) (58% vs. 50%, P = 0.0378) and for retreatment cases (47% vs. 35%, P = 0.0791), treatment success rates were similar. CONCLUSIONS: Community health worker support contributed to better TB control programme performance than an approach based exclusively on health facilities. Clear government policy and support for lay health worker programmes in TB control is needed.