3.2.1 Treatment support

Treatment administration options that are effective and suitable should be considered for each patient at the start of the patient’s treatment. Treatment support (an updated adaptation of directly observed treatment) is defined as another person (either a health-care worker or a lay person) helping a patient with TB take his/her TB medications, providing emotional support and medically intervention (or recognizing when medical intervention is necessary) in the case of non-response to therapy or adverse effects from treatment. However, some subgroups of patients with factors affecting treatment adherence are more likely or less likely to benefit from certain forms of treatment support than other patients are; or certain types of delivery of treatment support (e.g. location of treatment support or type of treatment support provider) are likely to work better than others. Consequently, an assessment is required at the start of treatment in order to choose the most appropriate treatment administration option for each patient. Treatment provided closer to the patient normally offers convenience for the patient and, therefore, achieves better outcomes. Treatment support delivered at home or in the community, near the patient’s home or workplace, should be considered as the preferred options as they have shown better outcomes than treatment support provided at a health-care facility, which is normally further away from the patient than the other options (15, 23).

The TB treatment supporter should maintain strict confidentiality regarding the patient’s disease and treatment. In some cases, this may require working out a system whereby the patient can receive medication without the knowledge of others. The TB treatment supporter should be someone whom the patient is comfortable with. The TB treatment supporter should have the appropriate training and skills. Although evidence shows that treatment support by a health-care worker, trained lay provider and family member displays advantages compared to unsupervised treatment, treatment support provided by trained lay providers and health-care workers are the preferred options and the least preferred treatment support provider is a family member (15).

In some settings and circumstances treatment support may be provided by health workers and in others by community members trained to deliver treatment for all forms of TB. While family-based treatment support has shown effectiveness in several settings, health-care workers should be aware that family relationships can be complicated for the TB patient, and as a result either the patient or the family TB treatment supporter may encounter subtle manipulation or abuse that can jeopardize adherence to treatment, management of adverse drug reactions and access to social support services. Training and education for health-care workers and treatment support providers are necessary to ensure the quality of treatment administration. Training and education can be done through many types of educational sessions, charts or visual reminders, educational tools and desktop aids for decision-making and reminders.

When in-person treatment support is not possible for the patient and treatment provider, digital adherence technologies, such as video-supported treatment (VST), short message service (SMS), telephone calls or other means of communication can be considered when they are available and can be used by both health-care providers and patients.

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