LSHTM Research Online

Lwilla, F; Schellenberg, D; Masanja, H; Acosta, C; Galindo, C; Aponte, J; Egwaga, S; Njako, B; Ascaso, C; Tanner, M; Alonso, P; (2003) Evaluation of efficacy of community-based vs. institutional-based direct observed short-course treatment for the control of tuberculosis in Kilombero district, Tanzania. Tropical medicine & international health , 8 (3). pp. 204-10. ISSN 1360-2276

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Abstract

Tuberculosis (TB) has reappeared as a serious public health problem. Non-compliance to antituber-culous 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 = 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.

Item Type:	Article
Keywords:	Adult, Antitubercular Agents/*therapeutic use, Community Health Aides, Community Health Services/*organization & administration, Delivery of Health Care/*organization & administration, *Developing Countries, Directly Observed Therapy/methods, Female, Human, Male, Middle Aged, Odds Ratio, Rural Health Services/organization & administration, Support, Non-U.S. Gov't, Tanzania, Treatment Outcome, Tuberculosis, Pulmonary/*drug therapy, Adult, Antitubercular Agents, therapeutic use, Community Health Aides, Community Health Services, organization & administration, Delivery of Health Care, organization & administration, Developing Countries, Directly Observed Therapy, methods, Female, Human, Male, Middle Aged, Odds Ratio, Rural Health Services, organization & administration, Support, Non-U.S. Gov't, Tanzania, Treatment Outcome, Tuberculosis, Pulmonary, drug therapy
Faculty and Department:	Faculty of Infectious and Tropical Diseases > Dept of Disease Control
PubMed ID:	12631309
Web of Science ID:	181485500004
URI:	http://researchonline.lshtm.ac.uk/id/eprint/15080

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