title: Evaluation of efficacy of community-based vs. institutional-based direct observed short-course treatment for the control of tuberculosis in Kilombero district, Tanzania.
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.
authors.affiliation: District Health Office, Ifakara, Tanzania.
authors.forename: Fred
authors.initials: F
authors.lastname: Lwilla
authors.forename: David
authors.initials: D
authors.lastname: Schellenberg
authors.forename: Honorath
authors.initials: H
authors.lastname: Masanja
authors.forename: Camilo
authors.initials: C
authors.lastname: Acosta
authors.forename: Claudia
authors.initials: C
authors.lastname: Galindo
authors.forename: John
authors.initials: J
authors.lastname: Aponte
authors.forename: Said
authors.initials: S
authors.lastname: Egwaga
authors.forename: Blasdus
authors.initials: B
authors.lastname: Njako
authors.forename: Carlos
authors.initials: C
authors.lastname: Ascaso
authors.forename: Marcel
authors.initials: M
authors.lastname: Tanner
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers; D003695:Delivery of Health Care / Q000458:organization & administration*; D003906:Developing Countries; D023801:Directly Observed Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019035:Rural Health Services / Q000458:organization & administration; D013636:Tanzania; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents