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.