DOT | ETA |
---|---|
Training: Standard nurse training for nurses; 5 day training for lay DOT supporters | Training: Additional 1 day induction to the ETA for nurses; additional 3 day induction to the programme for DOT supporters (now called treatment supporters); adherence counsellor training for ex-DOT supporters, including five days of programme training and five days of counselling training |
Patient is initiated onto directly observed therapy in the clinic (takes treatment once a day under supervision of the TB nurse) | Before initiating self-administered treatment, the patient is placed on directly observed therapy in the clinic for a short period (takes treatment once a day under the supervision of the TB nurse for approximately 2 weeks) to identify problems that might preclude self administration of treatment |
Mode of treatment delivery: directly observed therapy | Mode of treatment delivery: self administration at home with pill counts by treatment supporter |
Short information session about TB, and its treatment, given by the TB nurse | Trained lay adherence counsellor gives TB information to the participant in 3-4 counselling sessions, of half an hour each, focusing on treatment education, side effects, healthy living and adherence planning and TB and HIV |
No visits are made routinely to patients' homes | A treatment supporter conducts a home visit to document the patient's home circumstances and verify their address. TB contacts, immunocompromised persons and children under 5 years in the household are also referred to the clinic for testing and vaccinations |
No meeting of different role-players to discuss treatment support | Nurse, adherence counsellor and treatment supporter meet to discuss each patient's eligibility for self administration |
Patient can receive DOT in the workplace, or by visiting a DOT supporter in the community | Patient can take treatment in the workplace, or at a clinic, but can also obtain a one month supply of tablets from the clinic and self-supervise their treatment |
Nurse sees patient at diagnosis, for DOT, for 2/3 month sputum and at the end of treatment | Nurse sees patient at diagnosis, DOT for two weeks and, if the patient is eligible for self-administration, once per month until the end of treatment and for 2/3 month sputum and end of treatment sputum |
If the patient is placed on community based DOT, s/he visits a treatment supporter once a day to receive treatment. Maximum DOT supporter caseload is 30 patients per month. | If the patient is placed on the ETA model, a treatment supporter visits the patient three times in the first week and once a week thereafter to monitor treatment taking. Maximum treatment supporter caseload is 60 patients per month. |
No formal integration of family or friends into the treatment plan | Treatment "buddy" has an important role - s/he attends counselling and acts as a support and reminder to the patient. The buddy can be a friend, family member or neighbour of the patient |