Format

Send to

Choose Destination
BMC Infect Dis. 2015 May 8;15:210. doi: 10.1186/s12879-015-0945-5.

Community-based directly observed therapy (DOT) versus clinic DOT for tuberculosis: a systematic review and meta-analysis of comparative effectiveness.

Author information

1
Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia. Cameron.wright@utas.edu.au.
2
Spectrum Health, Grand Rapids, MI, USA. lmwesterkamp@gmail.com.
3
National Tuberculosis Centre, Thimi, Nepal. skor9113@uni.sydney.edu.au.
4
University of Western Sydney, Sydney, NSW, Australia. c.dobler@uws.edu.au.
5
NHMRC Centre of Research Excellence in Tuberculosis Control, University of Sydney, Sydney, NSW, Australia. c.dobler@uws.edu.au.

Abstract

BACKGROUND:

Directly observed therapy (DOT), as recommended by the World Health Organization, is used in many countries to deliver tuberculosis (TB) treatment. The effectiveness of community-based (CB DOT) versus clinic DOT has not been adequately assessed to date. We compared TB treatment outcomes of CB DOT (delivered by community health workers or community volunteers), with those achieved through conventional clinic DOT.

METHODS:

We performed a systematic review and meta-analysis of studies before 9 July 2014 comparing treatment outcomes of CB DOT and clinic DOT. The primary outcome was treatment success; the secondary outcome was loss to follow-up.

RESULTS:

Eight studies were included comparing CB DOT to clinic DOT, one a randomised controlled trial. CB DOT outperformed clinic DOT treatment success (pooled odds ratio (OR) of 1.54, 95% confidence interval (CI) 1.01 - 2.36, p = 0.046, I(2) heterogeneity 84%). No statistically significant difference was found between the two DOT modalities for loss to follow-up (pooled OR 0.86, 95% CI 0.48 to 1.55, p = 0.62, I(2) 83%).

CONCLUSIONS:

Based on this systematic review, CB DOT has a higher treatment success compared to clinic DOT. However, as only one study was a randomised controlled trial, the findings have to be interpreted with caution.

PMID:
25948059
PMCID:
PMC4436810
DOI:
10.1186/s12879-015-0945-5
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center