Evaluation of the palliative care program in patients with tuberculosis in Chirumhanzu District, Zimbabwe, 2021-2023

Introduction: The Kunda-Nqob’I TB program introduced the full package of Palliative Care to improve quality of life and treatment results for patients with tuberculosis (TB). The components of Palliative care include treatment adherence, physical, and psychosocial support. The physical support provides pain relief, while psychosocial support involves counselling patients to cope with the stress associated with TB. Treatment adherence included directly observed treatment by a community-based volunteer. Among the five districts in the Midlands province implementing Palliative Care, Chirumhanzu had the highest proportion of deaths in 2022. Methods: We conducted an analytical cross-sectional study with a retrospective record review to evaluate the Palliative Care program among patients with TB. We enrolled 125 health workers and community-based volunteers and reviewed 60 records. Checklists were used to assess inputs, and TB registers were reviewed to assess the outputs, and the package of palliative care received. Results: HIV- positive [aPOR= 10.52 (95% CI 1.83-60.6)], extrapulmonary [ aPOR= 6.8 (95% CI 1.46- 405)], and retreatment [aPOR= 11.4 (95% CI 1.75- 74.11)] were risk factors for unfavourable TB treatment outcomes. Health workers and community-based volunteers lacked knowledge. All facilities had human resources and registers. All six support and supervision visits were conducted. Among the 60 patients,46 (76%) received treatment adherence only, and 22 (36%) had unfavourable outcomes. Conclusion: HIV, extrapulmonary TB. and retreatment were associated with unfavourable TB treatment outcomes. While resources were adequate, most patients received treatment adherence only. The study highlights the need to address knowledge gaps among healthcare workers to improve treatment outcomes.