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PLoS One. 2017 May 18;12(5):e0178054. doi: 10.1371/journal.pone.0178054. eCollection 2017.

DOT or SAT for Rifampicin-resistant tuberculosis? A non-randomized comparison in a high HIV-prevalence setting.

Author information

1
Médecins Sans Frontières (MSF), Khayelitsha, South Africa.
2
Médecins Sans Frontières (MSF), South African Medical Unit, Cape Town, South Africa.
3
University of Cape Town (UCT), Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Cape Town, South Africa.
4
Médecins Sans Frontières (MSF), Cape Town, South Africa.
5
City of Cape Town Health Department, Cape Town, South Africa.

Abstract

BACKGROUND:

Daily directly-observed therapy (DOT) is recommended for rifampicin-resistant tuberculosis (RR-TB) patients throughout treatment. We assessed the impact of self-administered treatment (SAT) in a South African township with high rates of RR-TB and HIV.

METHODS:

Community-supported SAT for patients who completed the intensive phase was piloted in five primary care clinics in Khayelitsha. We compared final treatment outcomes among RR-TB patients initiating treatment before (standard-of-care (SOC)-cohort, January 2010-July 2013) and after the implementation of the pilot (SAT-cohort, January 2012-December 2014). All patients with outcomes before January 1, 2017 were considered in the analysis of outcomes.

RESULTS:

One-hundred-eighteen patients in the SOC-cohort and 174 patients in the SAT-cohort had final RR-TB treatment outcomes; 70% and 73% were HIV-co-infected, respectively. The proportion of patients with a final outcome of loss to follow-up (LTFU) did not differ whether treated in the SOC (25/118, 21.2%) or SAT-cohort (31/174, 17.8%) (P = 0.47). There were no significant differences in the time to 24-month LTFU among HIV-infected and uninfected patients (HR 0.90, 95% CI: 0.51-1.6, P = 0.71), or among patients enrolled in the SOC-cohort versus the SAT-cohort (HR 0.83, 95% CI: 0.49-1.4, P = 0.50) who received at least 6-months of RR-TB treatment.

CONCLUSION:

The introduction of SAT during the continuation phase of RR-TB treatment does not adversely affect final RR-TB treatment outcomes in a high TB and HIV-burden setting. This differentiated, patient-centred model of care could be considered in RR-TB programmes to decrease the burden of DOT on patients and health facilities.

PMID:
28542441
PMCID:
PMC5436852
DOI:
10.1371/journal.pone.0178054
[Indexed for MEDLINE]
Free PMC Article

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