Community DOT for tuberculosis in a Brazilian favela: comparison with a clinic model.
METHODS
Rio de Janeiro City, Brazil.


OBJECTIVE
To compare community-based directly observed treatment (DOT) for tuberculosis (TB), using community health workers (CHWs), with clinic-based DOT.


METHODS
In a longitudinal study in a cohort of TB patients in a region of Rio de Janeiro city, we evaluated treatment modalities and outcomes in 1811 patients diagnosed with TB between 1 January 2003 and 30 December 2004. Patients were offered DOT when they presented to out-patient clinics for an initial diagnosis. DOT was provided in the clinic or in the community, using CHWs, for patients living in a large favela. Outcomes of treatment were assessed using treatment registry databases.


RESULTS
Of the 1811 TB patients, 1215 (67%) were treated under DOT; among these, 726 (60%) received clinic-based treatment and 489 (40%) community-based treatment. Patients offered community-based treatment were more likely to accept DOT (99%) than those offered clinic-based treatment (60%, P<0.001). Treatment success rates for new smear-positive and retreatment TB cases were significantly higher among those treated with community-based DOT compared to clinic-based DOT.


CONCLUSIONS
We conclude that using CHWs to deliver DOT in the community may improve TB treatment outcomes in selected areas such as urban slums.
Cavalcante
S C
SC
Tuberculosis Control Program, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, Rio de Janeiro, Brazil. scavalcante@rio.rj.gov.br
Soares
E C C
EC
Pacheco
A G F
AG
Chaisson
R E
RE
Durovni
B
B
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001938:Brazil; D015331:Cohort Studies; D003153:Community Health Services; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011204:Poverty Areas; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents