Community Caregivers’ Experiences and Programmatic Strategies to Improve Active Case Finding in Community Tuberculosis Care in Botswana 2016-2021

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.

The Effects Community Tuberculosis Care Makes in the Early Identification and Referral of Tuberculosis Patients from Active Case Findings in Botswana

Setting: Twenty-two public health clinics offering Tuberculosis (TB) care at Francistown and Gaborone cities in Botswana. Objectives: To assess the effects of community tuberculosis care (CTBC) on the early identification and referral of patients and to identify perceived factors that contribute to effective active case findings and community referral system. Design: We adopted a concurrent triangulation mixed-method research design. Convenient purposive sampling was followed for both qualitative and quantitative phases. Data were collected from participants who met the inclusion criteria in both phases from July 2016-Dec. 2018. Consent was obtained from the all eligible participants. Results: We interviewed 40 caregivers with mean age of 43.4 years. We identified different themes, 83% (n = 33) accepted the caregiving role, 50% (n = 20) reported Social and physiological support from health workers, 23% (n = 10) received health education on TB, 20% (n = 8) and 30% (n = 12) reported teamwork and communication respectively between the health workers and caregivers as factors that contribute to effective active case findings in CTBC. 670 patients were enrolled in the quantitative phase and only 55% (n = 369) had their contact details documented in the patient’s TB records, while 94% (1311/1398) active case finding suspects/contacts screened for TB. Only 18% (115/1398) had been referred for investigated and 3% (35/1398) were TB positive. All patients underwent treatment. Conclusion: The caregiving role has been accepted in CTBC. Moreover, effects of CTBC on the early identification and referral of TB patients are commendable and can be improved.