Treatment outcomes of TB-infected individuals attending public sector primary care clinics in rural Liberia from 2015 to 2017: a retrospective cohort study

Publication Date:

09 Mar 2018


Wickett E, Peralta-Santos A, Beste J, Micikas M,  Toe F,  Rogers J, et al. (2018). Treatment outcomes of TB-infected individuals attending public sector primary care clinics in rural Liberia from 2015 to 2017: a retrospective cohort study. Trop Med Int Health. 23(5), 549-57. doi: 10.1111/tmi.13049



In June 2015, Partners in Health (PIH) and the Liberian Ministry of Health began a community health worker (CHW) programme containing food support, reimbursement of transport and social assistance to address gaps in tuberculosis (TB) treatment exacerbated by the 2014-2015 Ebola virus disease (EVD) epidemic. The purpose of this article was to analyse the performance of routine clinical TB care and the effects of this CHW programme.

Retrospective cohort study utilising data from TB patient registers at a census of all health facilities treating TB in the south-east region of Liberia from January 2015 – April 2017. Competing risks Cox regression analyses were used to generate subhazard ratios (sHR) analysing factors associated with rates of TB cure (smear negative), treatment completion (no smear), lost to follow-up (LTFU) and death.

LTFU rates decreased 76% pre- vs. post-CHW intervention, from 14.6% in preintervention to 3.4% post-intervention (P < 0.001). Although the post-intervention had better cure rates (sHR 1.07, CI 0.58-1.9), treatment completion (sHR 1.53, CI 1.00 2.39) and lower death rates (sHR 0.64, CI 0.34-1.2), statistical significance was not reached. Younger patients had significantly lower death and cure rates, while older patients had higher LTFU and cure rates. Overall, 31% of patients were cured, 44% completed treatment without a confirmatory smear, 5% were LTFU, 9% died, 0.5% failed treatment, and 10% transferred out.

In challenging environments, LTFU can be reduced by CHW accompaniment and socio-economic assistance to patients with TB. Approaches are needed to improve cure verification in young patients and reduce mortality.


Read the Full Article


Stand with HAI

Stand with HAI

Our Mission

Our mission is to promote policies and support programs that strengthen government primary health care and foster social, economic, and health equity for all. Our vision is a just world that promotes health and well-being, including universal access to quality health care.

Our History

Health Alliance International began in 1987 as a US-based international solidarity organization committed to supporting the public sector provision of health care for all.  Over 35 years, HAI conducted programs in 17 countries, with flagship programs in Mozambique, Côte d'Ivoire, and Timor-Leste.

Our Evolution

In line with HAI’s commitment to support and strengthen local public health leadership, as of October 2021, HAI fully transitioned global operations and active programs to locally-based, locally-led NGOs. Learn more about this shift toward local autonomy and equity in global health.

Didn't find what you were looking for?

Didn't find what you were looking for?