Evaluation of efficacy of community‐based vs. institutional‐based direct observed short‐course treatment for the control of tuberculosis in Kilombero district, Tanzania

Abstract

SummaryTuberculosis (TB) has reappeared as a serious public health problem. Non-compliance to antituberculous drug treatment is cited as one of the major obstacles to the containment of the epidemic. Compliance may be optimized by Directly Observed Treatment (DOT) and short-course treatment regimens. Since 1986, Tanzanian TB patients have received daily DOT at health facilities for the first 2 months of the treatment course. However, adherence and cure rates have been falling as the number of TB cases continues to increase and the burden on already stretched health facilities threatens to become unmanageable. We used an open cluster randomized controlled trial to compare community-based DOT (CBDOT) using a short-course drug regimen with institutional-based DOT (IBDOT). A total of 522 (301 IBDOT and 221 CBDOT) patients with sputum-positive TB were recruited. Overall, there was no significant difference in conversion and cure rates between the two strategies [M-H pooled odds ratio (OR) 0.62; 95% confidence interval (CI) 0.23, 1.71 and OR ¼ 1.58; 95% CI 0.32, 7.88, respectively] suggesting that CBDOT may be a viable alternative to IBDOT. CBDOT may be particularly useful in parts of the country where people live far from health facilities.

Where do tuberculosis patients go for treatment before reporting to DOTS clinics in southern Nigeria

“…Cost of treatment was also identified as a factor defining the use of the DOTS clinics in the study area. These agree with findings from other studies (Olumuyiwa et al, 2004;Lwilla et al, 2003;Enwuru et al, 2002;Auer et al, 2000;Wandwalo & Mørkve, 2000;Marinac et al, 1998;Needham et al, 1998).…”

Comparative Anti-mycobacterial Activity on Lowenstein-Jensen Slants of Selected Medicinal Plants Used in the Congolese Pharmacopeia

“…Being principally a disease of poverty, Tuberculosis (TB) is one of the oldest leading causes of morbidity and mortality and remains one of the deadliest communicable diseases in human history globally [1] [2]. It is caused by Mycobacterium tuberculosis (M. tuberculosis) and is an important public health concern [3][4][5].…”

Electronic monitoring of treatment adherence and validation of alternative adherence measures in tuberculosis patients: a pilot study

“…2 Studies have shown that community-based DOT is a cost-effective strategy that yields treatment outcomes similar to those obtained with facility-based DOT. [3][4][5][6] However, community-based DOT has been criticized for being beyond the control of health-care providers and hence conducive to self-administered (unsupervised) treatment and non-adherence. 6,7 The actual degree of adherence by patients on communitybased DOT has not yet been assessed.…”