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

Cameron M. Wright, Lenna Westerkamp, Sarah Korver, Claudia C. Dobler

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24 Citations (Scopus)

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.

Original languageEnglish
Article number210
JournalBMC Infectious Diseases
Volume15
Issue number1
DOIs
Publication statusPublished - 12 Dec 2015
Externally publishedYes

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Directly Observed Therapy
Meta-Analysis
Tuberculosis
Randomized Controlled Trials
Odds Ratio
Confidence Intervals

Cite this

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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.",
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Community-based directly observed therapy (DOT) versus clinic DOT for tuberculosis : A systematic review and meta-analysis of comparative effectiveness. / Wright, Cameron M.; Westerkamp, Lenna; Korver, Sarah; Dobler, Claudia C.

In: BMC Infectious Diseases, Vol. 15, No. 1, 210, 12.12.2015.

Research output: Contribution to journalArticleResearchpeer-review

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