Background: The community tuberculosis care program was started to reduce the impact of TB and increase successful treatment outcomes, thus contributing to meeting WHO targets on TB. According to the Botswana Ministry of Health, community tuberculosis care was introduced with the main goal of reducing tuberculosis-related morbidity and mortality among communities through the expansion of direct observed therapy and community involvement to community settings. The community caregivers were to support tuberculosis patients throughout their treatment period until they were cured or had completed their treatment. Settings: Two major cities of Botswana, Francistown and Gaborone, with more than twenty-two health clinics offering tuberculosis care. Objective: To investigate community caregivers’ experiences and identify programmatic strategies to improve active TB case findings under the community TB care (CTBC) program in Botswana during 2016-2021. Methods: We adopted a descriptive qualitative research design, followed by convenience purposive sampling. We obtained consent and interviewed 40 participants who met the inclusion criteria, 16 out of 73 in Gaborone and 24 out of 38 from Francistown. Results: We interviewed 40 caregivers with a mean age of 43.4 years. Accepting the caregiving role was identified as the main experience by more than two thirds of the caregivers. While at least more than two-fifth felt obligated to care for the patient at home due to personal relations. More than half of the respondents found caregiving difficult or frustrating due to some challenges encountered during the caregiving role. Behavioral modifications were suggested under different subthemes as strategies to improve active case finding. [-rId13-]Conclusion: Acceptance was the major experience in CTBC. Intensification of known programmatic strategies was suggested by caregivers to improve tuberculosis active case finding in CTBC.
References
[1]
World Health Organization (2019) Global Tuberculosis Report 2019. WHO, Geneva.
[2]
World Health Organization (2017) Global Tuberculosis Report 2017. WHO, Geneva.
[3]
World Health Organization (2015) Global Tuberculosis Report 2015. WHO, Geneva.
[4]
Ministry of Health (of Botswana) (2011) National Tuberculosis Programme: (BNTP) Botswana Community Tuberculosis Care Policy Guidelines. Government Printer, Gaborone.
[5]
Ministry of Health (of Botswana) (2018) National Tuberculosis Programme Manual. 7th Edition, Government Printers, Gaborone.
[6]
Ministry of Health (of Botswana) (2012-2013) Report on Evaluation of Community Tuberculosis Approaches in Botswana. Government Printers, Gaborone.
[7]
Ministry of Health (of Botswana) (2013) National Tuberculosis Control Program, Strategic Plan 2013-2017. Government Printers, Gaborone.
[8]
World Health Organization (2014) The End TB Strategy: Global Strategy and Targets for Tuberculosis Prevention, Care and Control after 2015. WHO, Geneva.
[9]
African Comprehensive HIV/AIDS Partnerships (2013) Annual Report. Partnerships for a Healthy in Africa, Gaborone.
[10]
George, J.B. (2011) Nursing Theories: The Bases for Professional Nursing Practice. 6th Edition, Pearson, Boston.
[11]
Masters, K. (2015) Nursing Theories: A Framework for Professional Practice. 2nd Edition, Jones & Bartlett Learning, Burlington.
[12]
Bringardner, P., Sentsho, M., Shenoi, S. and Lazenby, M. (2020) Acceptability of Community-Based Tuberculosis Care in Botswana. https://www.researchgate.net/publication/331035638
[13]
Oliver, M., Geniets, A., Winters, N., Rega, I. and Mbae, S.M. (2015) What Do Community Health Workers Have to Say about Their Work, and How Can This Inform Improved Programme Design? A Case Study with CHWs within Kenya. Global Health Action, 8, Article 27168. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC4442123/ https://doi.org/10.3402/gha.v8.27168
[14]
Tulloch, O., Thebald, S., Morishita F., Dakoti, D.G., Asnake, G., Tesema, T., Jamal, H., Markos, P., Cuevas, L.E. and Yassin, M.A. (2015)Patient and Community Experiences of Tuberculosis Diagnosis and Care within a Community-Based Intervention in Ethiopia: A Qualitative Study. BMC Public Health, 15, Article No. 187. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC4349713/ https://doi.org/10.1186/s12889-015-1523-x
[15]
Ndima, S.D., Sadit, M., Give, C., Ormel, H., Kok, M.C. and Taegtmeyer, M. (2015) Supervision of Community Health Workers in Mozambique: A Qualitative Study of Factors Influencing Motivation and Programme Implementation. Human Resources for Health, 13, Article No. 63. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC4556309/ https://doi.org/10.1186/s12960-015-0063-x
[16]
Okelloh, D., Achola, M., Opole, J., Ogwang, C., Agaya, J., Sifuna, P., Mchembere, W., Cowden, J., Heilig, M., Borgdorff, M.W., Yuen, C.M. and Cain, K.P. (2019) Lessons Learned from Community-Based Tuberculosis Case-Finding in Western Kenya. Public Health Action, 9, 53-57. https://doi.org/10.5588/pha.18.0085
[17]
Mohajer, D. and Singh, N. (2018) On Factors Enabling Community Health Workers and Volunteers to Overcome Socio-Cultural Barriers to Behavior Change: Meta-Synthesis Using the Concept of Social Capital. Human Resources for Health, 16, Article No. 63. https://doi.org/10.1186/s12960-018-0331-7
[18]
Viney, K.A., Johnson, P., Tagaro, M.M., Fanai, S., Linh, N.N., Kelly, P., Harley, D. and Sleigh, A. (2014) Tuberculosis Patient’s Knowledge and Beliefs about Tuberculosis: A Mixed Methods Study from the Pacific Islands Nation of Vanuatu. BMC Public Health, 14, Article No. 467. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC4033676/ https://doi.org/10.1186/1471-2458-14-467
[19]
Lukman, M., Ibrahim, K., Yani, D.P., Sari, S.P. and Juniarti N. (2019) Exploring Strategies to Improve the Performance of Community Health Volunteers for Tuberculosis Care and Prevention: A Qualitative Study. International Journal of Community Based Nursing and Midwifery, 7, 270-278.
[20]
Sekandi, J.N., Dobbbin, K., Oloya, J., Okwera, A., Whalen, C.C. and Corso, P.S. (2015) Cost-Effectiveness Analysis of Community Active Case Finding and Household Contact Investigation for Tuberculosis Cases Detection in Urban Africa. PLOS ONE, 10, e0117009. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC4319733/ https://doi.org/10.1371/journal.pone.0117009
[21]
Ochom, E., Meyer, A.J., Armstrong-Hough, A., Kizito, S., Ayakaka, I., Turimumahoro, P., Ggita, J.M., Katamba, A. and Davis, J.L. (2018) Integrating Home HIV Counselling and Testing into Household TB Contact Investigation: A Mixed Method Study. Public Health Action, 8, 72-78. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC6012957/ https://doi.org/10.5588/pha.18.0014
[22]
MacPherson, P., Webb, E.L., Variava, E., Lala, S.G., Milovanovic, M., Ratsela, A., Lebina, L., Kinghorn, A. and Martinson, N.A. (2019)Intensified Household Contact Tracing, Prevention and Treatment Support versus Enhanced Standard of Care for Contacts of Tuberculosis Cases in South Africa: Study Protocol for a Household Cluster-Randomised Trial. BMC Infectious Diseases, 19, Article No. 839. https://doi.org/10.1186/s12879-019-4502-5
[23]
Little, K.M., Msandiwa, R., Martinson, N., Golub, J., Chaisson, R. and Dowdy, D. (2018) Yield of Household Contact Tracing for Tuberculosis in Rural South Africa. BMC Infectious Diseases, 18, Article No. 299. https://doi.org/10.1186/s12879-018-3193-7
[24]
Yuen, C.M., Agaya, J., Mchembere, W., Okelloh, D., Achola, M., Opole, J., Cowden, J., Heilig, C.M., Borgdorff, M.W. and Cain, K.P. (2019) Optimizing the Efficiency of Tuberculosis Active Case-Finding in Health Facilities and Communities. International Journal of Tuberculosis and Lung Disease, 7, 844-849. https://doi.org/10.5588/ijtld.18.0700
[25]
Parvaresh, L., Bag, S.K., Cho, J.-G., Heron, N., Assareh, H., Norton, S., Corbett, S. and Marais, B.J. (2018) Monitoring Tuberculosis Contact Tracing Outcomes in Western Sydney, Australia. BMJ Open Respiratory Research, 5, e000314. https://doi.org/10.1136/bmjresp-2018-000341
[26]
Baliashvili, D., Kempker, R.R., Blumberg, H.M., Kuchukhidze, G., Merabishvilli, T., Aslanikashvilli, A. and Magee, M.J. (2018) A Population-Based Tuberculosis Contact Investigation in the Country of Georgia. Public Health Action, 8, 110-111. https://doi.org/10.5588/pha.18.0024
[27]
Kerrigan, D., West, N., Tudor, C., Hanrahan, C.F., Lebina, L., Msandiwa, R., Mmolawa, L., Martinson, N. and Dowdy, D. (2017) Improving Active Case Finding for Tuberculosis in South Africa: Informing Innovative Implementation Approaches in the Context of the Kharitode Trial through Formative Research. Health Research Policy and System, 15, Article No. 42. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC5450237/ https://doi.org/10.1186/s12961-017-0206-8
[28]
Musuka, G., Teveredzi, V., Busang, L., Chingombe, I., Makadzange, P., Mokgweetsinyana, S., Ncube, R., Maradzika, J., Chinamasa, C.F. and Moeti, T. (2018) Community Attitudes on Tuberculosis in Botswana: An Opportunity for Improving the National Tuberculosis Programme Outcomes, 2011. BMC Research Notes, 11, Article No. 499. http://www.ncbi.nlm.nih.gov/pmc/artilces/PMC60557039/ https://doi.org/10.1186/s13104-018-3585-1
[29]
Yassin, M.A., Datiko, D.G., Tulloch, O., Markos, P., Aschalew, M., Shargie, E.B., Dangisso, M.H., Komatsu, R., Sahu, S., Blok, L., Cuevas, L.E. and Thebald, S. (2013) Innovative Community-Based Approaches Doubled Tuberculosis Case Notification and Improve Treatment Outcome in Southern Ethiopia. PLOS ONE, 8, e63174. https://journals.plos.org/plosone/ https://doi.org/10.1371/journal.pone.0063174
[30]
Querri, A., Ohkado, A., Yoshimatsu, S., Coprada, L., Lopez, E., Medina, A., Garfin, A., Bermejo, J., Tang, F. and Shimouchi, A. (2017) Enhancing Tuberculosis Patient Detection and Care through Community Volunteers in the Urban Poor, the Philippines. Public Health Action, 7, 268-274. https://doi.org/10.5588/pha.17.0036
