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

Citation

Wright, CM and Westerkamp, L and Korver, S and Dobler, CC, Community-based directly observed therapy (DOT) versus clinic DOT for tuberculosis: a systematic review and meta-analysis of comparative effectiveness, BMC Infectious Diseases, 15 Article 210. ISSN 1471-2334 (2015) [Refereed Article]


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Copyright Statement

2015 Wright et al. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

DOI: doi:10.1186/s12879-015-0945-5

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, I2 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, I2 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.

Item Details

Item Type:Refereed Article
Keywords:Tuberculosis Directly observed therapy DOT Community-based DOT Clinic DOT Adherence
Research Division:Medical and Health Sciences
Research Group:Clinical Sciences
Research Field:Infectious Diseases
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Infectious Diseases
Author:Wright, CM (Mr Cameron Wright)
ID Code:121093
Year Published:2015
Web of Science® Times Cited:7
Deposited By:Office of the School of Medicine
Deposited On:2017-09-08
Last Modified:2017-10-20
Downloads:10 View Download Statistics

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