The significant time lag is essential for surgical intervention programs to resume counseling for patients previously refusing TT surgery: Experiences of IMA World Health in Tanzania

Introduction: A simple eyelid surgery can spare vision for those affected by blinding Trachomatous trichiasis (TT), an advanced stage of trachoma in which the eyelashes turn inward towards the eyeball. In Tanzania, IMA World Health (IMA) provides TT surgery free of charge through the SAFE program. Despite counseling services provided for every TT patient, including additional counseling sessions for patients refusing surgery, those with confirmed cases sometimes refuse surgery, reducing the average surgical uptake to below 80%. In some cases, a patient who refused surgery will later request surgery.

Methods: Researchers analyzed cases of 28 patients in the Masasi district who initially refused surgery but later requested surgery to understand correlating factors with refusal and best practices to increase surgical uptake.

Results: Overall, the number of patients accepting surgery remains unacceptably low. However, fourteen months after potential surgery, patients received their final counseling session. IMA targeted the 28 patients who had previously refused surgery. Of these patients, case finders brought in 26 (92.8%), and 19 (73%) accepted and received surgery right away.

Conclusion: IMA's experience shows that, for a surgical intervention program to increase surgical acceptance among patients previously refusing surgery, the program should enforce a significant time lag between the final counseling session and a restart of counseling services for previously refusing patients. This is due to the patient's eye problem continually worsening over time, influencing positive health-seeking behavior. Additionally, a time lag is essential for refusing the patient to contact other individuals who had benefitted from the program. It also allows those who refused surgery to gain more trust and have a positive outlook of program services, thus ultimately requesting surgical treatment.