title: Cohort analysis of directly observed treatment outcomes for tuberculosis patients in urban Pakistan.
abstract: BACKGROUND
  This quasi-experimental cohort study aimed to evaluate World Health Organization (WHO) defined tuberculosis (TB) treatment outcomes for patients under directly observed treatment at a health facility (clinic DOT) or at home (family DOT) in urban Pakistan.
  
  
  METHODS
  We enrolled 582 sputum smear-positive TB patients being treated by either clinic DOT (n = 295) or family DOT (n = 287) in 11 treatment centres. Patients and/or family members were interviewed for baseline measurements. WHO-defined treatment outcomes were evaluated at the end of treatment. Proportions of 'cured' patients were computed. A log-binomial model was used to evaluate the associations of various factors with 'cured' status.
  
  
  RESULTS
  The proportion of 'cured' patients was respectively 66% and 34% in the clinic DOT and family DOT groups (risk difference 0.32; 95%CI 0.24-0.39). Patients on clinic DOT were more likely to achieve cure (adjusted relative risk [RR(adj)] 1.85; 95%CI 1.43-2.39) than those on family DOT, as were patients satisfied with their health care worker's attitude (RR(adj) 5.73; 95%CI 2.54-12.96).
  
  
  CONCLUSIONS
  Clinic DOT nearly doubled the proportion of cured patients compared to family DOT. Efforts to improve care-provider attitudes to enhance patient satisfaction, and effective implementation of the WHO's public-private mix approach, may enhance TB control in this and similar settings.
authors.affiliation: Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Jabriya, Kuwait. saeed.akhtar@hsc.edu.kw
authors.forename: S
authors.initials: S
authors.lastname: Akhtar
authors.forename: S
authors.initials: S
authors.lastname: Rozi
authors.forename: F
authors.initials: F
authors.lastname: White
authors.forename: R
authors.initials: R
authors.lastname: Hasan
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D015331:Cohort Studies; D023801:Directly Observed Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010154:Pakistan; D017060:Patient Satisfaction; D012044:Regression Analysis; D012074:Remission Induction; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D019037:Urban Health Services; D014944:World Health Organization; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents