Workplace-based DOT may have advantage in promoting successful treatment in patients who continue to work during treatment. Regarding positive treatment outcomes cured treatment, completed treatment and successful treatment , a review by Lewin et al. However, the review by Volmink and Garner found no significant difference in clinical outcomes cure or completion of treatment between DOT at a clinic versus DOT by a family member or community health worker, or DOT provided by a family member versus a community health worker [ 21 ].
In addition, this meta-analysis identified that CB-DOT promoted cured treatment and successful treatment compared with self-administration one RCT and two cohort studies, fixed model , but workplace DOT had an advantage in successful treatment compared with CB-DOT, based on two cohort studies with no significant heterogeneity. Regarding negative treatment outcome default, death, failure, and transfer out , one systematic review and meta-analysis by Toczek et al. A previous review [ 21 ] concluded that within CB-DOT, comparisons between DOT provided by a family member versus a community health worker had similar outcomes.
Similar to our findings, the review by Karumbi and Garner evaluated DOT [ 22 ] compared to self-administered treatment in people on treatment for active TB or on prophylaxis to prevent active disease, and demonstrated little or no difference in cure or treatment completion when DOT was implemented by a family member compared with DOT by community health worker [ 22 ]. Another systematic review [ 23 ] concluded that DOT was not significantly better than self-administered therapy in preventing microbiologic failure, relapse, or acquired drug resistance.
Our review has some limitations. First, the DOT intervention varied in different studies. Many had additional measures to promote treatment compliance [ 15 — 16 ], while some studies did not mention additional measures [ 39 — 40 , 44 ]. The differences in the additional measures in different studies were possible reasons for the heterogeneity between studies. However, we could not conduct subgroup analysis or sensitivity analysis because of the limitations in the available data. Second, this review did not cover the impact of CB-DOT on the risk of relapse and time to relapse as well as latent TB infection because few relevant studies were identified.
This outcome should focus on death from TB and exclude death from causes other than TB. Finally, the RCTs included in our review did not report which data adhered to the principle of intention-to-treat. Equally, we only included published studies in this review, and this may have led to publication bias [ 51 ]. Though a plethora of factors are associated with preventive or curative TB treatment [ 52 ], evidence from this meta-analysis shows that CB-DOT, as one key component of community involvement in TB control, can improve TB treatment outcomes.
CB-DOT has the potential to contribute to better treatment outcomes, particularly in low-to-middle income countries with high TB burden because of its convenience [ 19 , 29 , 53 ] and cost-effectiveness [ 49 ], and may enable substantial savings in indirect costs associated with clinic-based treatment, including travel costs, child care costs, and loss of earnings.
Implementation research is use of strategies to adopt, adapt, integrate evidence-based health interventions and policies, and change practice patterns within specific settings [ 53 — 55 ]. Therefore, further implementation research on strategies for implementing CB-DOT in specific community settings would help to provide guidance on how best to integrate evidence-based CB-DOT into the healthcare system [ 53 , 55 ]. Offering financial incentive to CB-DOT providers are more likely to increase motivation and their effectiveness, but further studies are needed to confirm this hypothesis.
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Possibly, it is a promising strategy to scale up CB-DOT in low-to-middle income countries with high TB burden, because it is cost-effective and acceptable. CB-DOT interventions could benefit from further implementation studies to ensure proper tailoring of interventions in line with constraints and resources of the local settings in which they are implemented. Conceived and designed the experiments: YL ST.
Performed the experiments: YL HZ. Analyzed the data: YL HZ.
Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Poor adherence to tuberculosis TB treatment can lead to prolonged infectivity and poor treatment outcomes. Results Seventeen studies involving 12, pulmonary TB patients PTB in eight randomized controlled trials RCTs and nine cohort studies from 12 countries met the criteria for inclusion in this review and 14 studies were included in meta-analysis.
For studies that reported treatment outcomes of participants with smear-positive TB and smear-negative TB, and new or retreated TB and ex-pulmonary TB patients separately, [ 4 , 16 , 26 , 27 ], we only included results of TB patients without ex-pulmonary TB. Outcomes measures : We used the following definitions of treatment outcomes for non MDR-TB [ 1 , 34 ]: i Successful treatment: a patient who was cured or who completed treatment; ii Cured treatment: a patient who was initially sputum smear-positive and who was sputum smear-negative in the last month of treatment and on at least one previous occasion; iii Completed treatment: a patient with sputum smear-positive or sputum smear-negative pulmonary TB who completed treatment; iv death: a patient who died from any cause during treatment; v Failure: a patient who was initially sputum smear-positive and who remained sputum smear-positive at month 5, or was later found to have a MDR strain at any point during treatment, whether they were smear-negative or smear-positive; vi Default: a patient whose treatment was interrupted for two consecutive months or more; and vii Transfer out: a patient who was transferred to another reporting unit and whose treatment outcome was unknown.
Study selection Two reviewers HZ and YL used the above inclusion and exclusion criteria to identify relevant studies.
Quality assessment Two reviewers HZ and YL independently assessed the methodological quality of included studies. Data abstraction Data from eligible studies were independently abstracted by two reviewers HZ and YL. Data Synthesis The first step in data analysis involved a synthesis aimed at summarizing, comparing, and contrasting the extracted data. Results Description of studies Fig 1 presents an illustration of the search output.
Download: PPT. Table 1. General information for included studies for Community Based intervention and Treatment 17studies. Table 2. CB-DOT vs. Table 3.
Subgroup analysis. Discussion DOT was launched by WHO in [ 47 ], and has long been accepted as an effective strategy to promote patient adherence to anti-TB treatment, thus helping to cure most TB cases, to prevent the spread of TB in the community, and to prevent drug-resistant TB [ 48 ]. Limitations Our review has some limitations. Implications Though a plethora of factors are associated with preventive or curative TB treatment [ 52 ], evidence from this meta-analysis shows that CB-DOT, as one key component of community involvement in TB control, can improve TB treatment outcomes.
Supporting Information. S1 Table. Quality Assessment of included studies. S2 Table. S1 Text. Search strategies. References 1. World Health Organization. Global tuberculosis report Int J Tuberc Lung Dis. Cad Saude Publica. Trop Med Int Health.
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