Abstract
BackgroundAmbulatory based treatment of tuberculosis has been recently introduced in Kazakhstan. We sought to assess the attitudes of the general population, TB patients and their household members towards ambulatory TB treatment and identify how knowledge of TB is associated with these attitudes.MethodsNew pulmonary TB cases and their household and community controls were recruited from three regions of Kazakhstan in 2012–2014. 1083 participants completed audio computer-assisted self interviews to assess their knowledge of TB and attitudes towards ambulatory care. Mixed effects logistic regression models were used to identify factors associated with attitudes toward ambulatory TB treatment.ResultsThe proportion of people who considered ambulatory TB treatment as appropriate was very low (24.9%). Positive attitudes towards ambulatory TB treatment were significantly associated with region of residence, higher level of education, family support and experience with TB. The association between sufficient tuberculosis knowledge and favorable attitude toward ambulatory treatment was stronger among community controls compared to TB patients and their family members.ConclusionsThis study provides insight into attitudes toward ambulatory TB treatment among different groups and the specific influence of TB knowledge on these attitudes. Our findings can inform the process of integration of new TB treatment strategies and the development of appropriate education and advocacy programs in the general population.
Highlights
Ambulatory based treatment of tuberculosis has been recently introduced in Kazakhstan
The proportion of study participants with sufficient Multidrug-resistant tuberculosis (TB) knowledge was highest among cases (67.7%), followed by household controls (52.3%) and community controls (47.7%)
Among TB cases, 20% of respondents reported having someone from their family diagnosed with TB and 18.9% of TB cases reported having someone with TB among their frequent contacts
Summary
Ambulatory based treatment of tuberculosis has been recently introduced in Kazakhstan. To control a growing epidemic of TB, Kazakhstan introduced the National Tuberculosis Program (NTP) and World Health Organization’s Directly Observed Treatment, Short-Course (WHO’s DOTS) strategy in 1998. Through these efforts, TB incidence rates declined in the country; TB still remains a major public health concern in Kazakhstan due to the rapid increase of drug-resistant strains. Treatment at the ambulatory level is more cost-effective, reduces the risk of nosocomial transmission of drug resistant strains, and facilitates patients receiving comprehensive health services, including psychosocial care and support [10,11,12]. Ambulatory treatment helps to shift treatment closer to places where patients live and allows patients to be more independent [13]
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