TURBERCULOSIS still claims 1.7 million victims per year worldwide, mostly in developing countries. TB Patients in Tanzania have two options now based on the Patients-Centred TB Treatment (PCT) approach.

The Principal Research Scientist of National Institute for Medical Research (NIMR), Dr Nyagosya Range says patients now have the choice to either take the daily treatment at a health facility, supervised by a medical professional as under the Directly Observed Treatment Short-course (DOTS), or at home, supported by a family or community member.

Tanzania is a high-burden country with about 60,000 new TB cases annually. Since 2005 Novartis Foundation for Sustainable Development donates gold standard TB medicines for the treatment of all adult patients in the country.

According to the statement issued by the NFSD the fixeddose combination therapy shortens the treatment period from eight to six months. The donation is made available through the Global Drug Facility (GDF) of the stop TB Partnership, which is hosted by the World Health Organisation (WHO).

TB is very complex to treat, as it requires a combination of daily drugs over a half-year treatment period. In order to avoid resistances over the long treatment period, the WHO recommends DOTS. Critique and medical analysts concur that although DOTS ensures better patients adherence, it poses a burden on both providers and patients: Already overstrained healthcare personnel face an increased work load.

On the other hand, patients have to walk long distances everyday to receive their medication, which often results in treatment drop outs among patients, thanks to the Novartis Foundation for Sustainable Development and its partners including the Ministry of Health and Social Welfare, the National Institute for Medical Research (NIMR) and the Tanzania Training Centre for International Health- Ifakara.

Some patients who were under the PCT-Treatment in some areas of Morogoro, Dar es Salaam and Coast Region said that it has helped to make them adhere to the treatment. PCT was first introduced and tested in three pilot districts- one urban and two rural (Arusha city, Mufindi - Iringa Region and Kahama- Tabora Region.

Some of the interviewees have expressed great relief through the home based treatment support, saying it has taken away from them the burden of walking long distances to the clinic everyday. Speaking to this reporter in a remote village of Morogoro and Ifakara, Elias Juma (not his real name) said that he was under the home based treatment approach.

"I was very weak when I first visited the clinic in Ifakara from a remote village. It would have rendered my movement to the clinic almost impossible, thanks to the PCT approach," he said. He notes that when he was found to be TB positive he was coughing too much, and sweating at night with high fever.

He also says that he was not smoking but he used to drink local brew which the culture in some villages is to pass over the container to several people in a gathering who share the drink. Asked who had convinced him to visit the clinic, he said that his father had advised him to do so adding that the health centres' TB-PCT coordinators were doing a wonderful job.

"I was given proper instructions by the clinical officers that I risked developing resistance with the TB drugs if I stopped taking them regularly for six months. "This lesson has sunk in my mind and I know the risks of breaking the drug cycle," he said.

Explaining the homebased treatment, the Principal Research Scientist says that the patient and treatment supporter are required to visit the health facility once a week during the 2-month intensive phase to collect a new blister pack. She said that during the continuation phase which lasts 4 months, they are required to visit the health facility once every two weeks.

Therefore patients can skip the daily walks to health facilities and avoid transport costs, and health workers can allocate the gain in time to other patients, she added. Speaking at the Workshop organised by the TTCIH and sponsored by Novartis employees based in Spain, the Director of the institute, Prof. Senga Pemba said that this workshop was timely since the prevalence of TB was not declining.

"We do not concede defeat we shall continue to use different approaches including Patient Centred Treatment to combat the disease," he said. He said that the training will be rolled out to other regions in the country to ensure that the health centres help the TB patients to get treatment at most convenient way.

"This PCT approach is initiated here (TTCIH) in collaborations with our partners, I am sure that the World Health Organisation will adopt this model too. He commended effort of Novartis employees who donated 18,580 Euro saying that it was something that Tanzanians should emulate. We are trying to move away from the old practices that doctors are directors of patients care," he said.

PCT shows how we care for patients and simply engage him while also giving him certain responsibilities so that he can make a decision. "This approach will help to minimise use of scarce resources in the health sector, and bring enhanced diagnostic satisfaction, to make the patients feel that they own the care and are partners to the care," he emphasised.

The PCT approach has started gaining momentum, as the Survey carried out by this paper in some clinics show that the number of home-based treatment were on the increase. The TB-PCT coordinator for Kibaoni health facility who is keeping records for the whole Kilombero district said that the majority of the patients preferred home-based treatment.

The Sunday News which had access to the register saw over 300 patients who are home based. But the PCT approach has also encountered some serious problems. There were revelations during the visit to the Kibaoni health facility that there was lack of supervision in terms of delivering the right information to the patients.

Another problem was inadequate handing over of the office, which affected the successor to implement the PCT approach efficiently. Some of the interventions made by the National Institute of Medical Research officer were to examine the system, which has helped to expose some of the short falls.

A research which was carried out in some regions including Dar es Salaam, some patients who are living in Temeke were found to be TB positive. One of the reasons given by NIMR official was that they had no proper education on the disease, which ended up spreading in the whole family.

One of the interventions that Novartis and its partners have embarked on is the Video on PCT implementation which will continue to be circulated all over the country to help health workers better understand the TB-PCT approach and implement it accordingly.

The challenge ahead is how will the health centres synchronise their records and give proper counselling to the patients on the options whether they should go for home-based treatment or health centre treatment without influencing their decision.