title: Community-based treatment for multidrug-resistant tuberculosis in rural KwaZulu-Natal, South Africa.
abstract: METHODS
  Hlabisa health sub-district, KwaZulu-Natal, South Africa.
  
  
  OBJECTIVE
  To describe the establishment of a community-based multidrug-resistant tuberculosis (MDR-TB) treatment programme embedded in the district TB control programme and to evaluate whether early outcomes are comparable to those in the traditional hospital-based model of care.
  
  
  METHODS
  Cases who initiated community-based MDR-TB treatment (CM) between March and December 2008 were compared with patients who initiated MDR-TB treatment under the traditional hospital-based model of care (TM) between January 2001 and February 2008. Time to initiation of treatment and time to sputum smear and culture conversion were compared for the two groups in Kaplan-Meier survival curves using the Mantel-Cox log-rank test.
  
  
  RESULTS
  Overall, 50 CM cases and 57 TM cases were included; 39 of the 50 CM cases (78.0%) were human immunodeficiency virus positive. The median time to initiation of treatment was 84 days for CM and 106.5 days for TM (P = 0.002). Median time to sputum smear conversion was shorter for CM than TM (59 vs. 92 days, P = 0.055), as was time to sputum culture conversion (85 vs. 119 days, P = 0.002).
  
  
  CONCLUSIONS
  Community-based treatment for MDR-TB can be implemented within the existing TB control programme in rural South Africa and should be scaled up where resources allow.
authors.affiliation: Hlabisa Hospital, Hlabisa, KwaZulu-Natal, South Africa. rlessells@africacentre.ac.za
authors.forename: T
authors.initials: T
authors.lastname: Heller
authors.forename: R J
authors.initials: RJ
authors.lastname: Lessells
authors.forename: C G
authors.initials: CG
authors.lastname: Wallrauch
authors.forename: T
authors.initials: T
authors.lastname: Bärnighausen
authors.forename: G S
authors.initials: GS
authors.lastname: Cooke
authors.forename: L
authors.initials: L
authors.lastname: Mhlongo
authors.forename: I
authors.initials: I
authors.lastname: Master
authors.forename: M L
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003153:Community Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006297:Health Services Accessibility / Q000458:organization & administration*; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration; D006760:Hospitalization; D006767:Hospitals, District / Q000458:organization & administration; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D013019:South Africa / Q000453:epidemiology; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000995:Antitubercular Agents