title: Success of community-based directly observed anti-tuberculosis treatment in Mongolia.
abstract: BACKGROUND
  Many countries restrict access to directly observed therapy (DOT) for tuberculosis (TB) to government health facilities. More innovative approaches are required to reduce non-adherence, improve patient outcomes and limit the risk of selecting drug-resistant strains.
  
  
  METHODS
  We performed a retrospective cohort study in sputum smear-positive patients treated with community-based DOT (home-based DOT or 'lunch' DOT, whereby DOT is provided with a free daily meal once sputum smear conversion has been documented), and conventional clinic-based DOT in Ulaanbaatar, the capital of Mongolia, in 2010-2011. We compared treatment success using community-based home DOT vs. conventional clinic DOT and describe treatment completion rates using lunch DOT.
  
  
  RESULTS
  The overall treatment success among new sputum smear-positive TB patients was 85.1% (1505/1768). Patients receiving community DOT had higher cure rates (294/327, 89.9% vs. 1112/1441, 77.2%; aOR 2.66, 95%CI 1.81-3.90) and higher treatment success (306/327, 93.6% vs. 1199/1441, 83.2%; aOR 2.95, 95%CI 1.85-4.71, P < 0.001) than those treated with clinic DOT. Apart from one death, treatment completion was 100% among patients who received lunch DOT after sputum smear conversion.
  
  
  CONCLUSIONS
  Community DOT improved treatment success in Ulaanbaatar, Mongolia. It should now be scaled up to be made available for more patients and in all regions of the country.
authors.affiliation: National Health and Medical Research Council Centre of Research Excellence in Tuberculosis Control, University of Sydney, Sydney, Australia; Department of Respiratory Medicine, Liverpool Hospital and South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: C C
authors.initials: CC
authors.lastname: Dobler
authors.affiliation: Mongolian National Tuberculosis Programme, National Centre for Communicable Diseases, Ulaanbaatar.
authors.forename: S
authors.initials: S
authors.lastname: Korver
authors.affiliation: Mongolian National Tuberculosis Programme, National Centre for Communicable Diseases, Ulaanbaatar, Mongolia.
authors.forename: O
authors.initials: O
authors.lastname: Batbayar
authors.affiliation: Mongolian National Tuberculosis Programme, National Centre for Communicable Diseases, Ulaanbaatar, Mongolia.
authors.forename: S
authors.initials: S
authors.lastname: Oyuntsetseg
authors.affiliation: Mongolian National Tuberculosis Programme, National Centre for Communicable Diseases, Ulaanbaatar, Mongolia.
authors.forename: B
authors.initials: B
authors.lastname: Tsolmon
authors.affiliation: Mongolian Anti-Tuberculosis Association, Ulaanbaatar, Mongolia.
authors.forename: C
authors.initials: C
authors.lastname: Wright
authors.affiliation: Mongolian Anti-Tuberculosis Association, Ulaanbaatar, Mongolia.
authors.forename: B
authors.initials: B
authors.lastname: Solongo
authors.affiliation: National Health and Medical Research Council Centre of Research Excellence in Tuberculosis Control, University of Sydney, Sydney, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D003153:Community Health Services; D023801:Directly Observed Therapy; D005260:Female; D005522:Food Services; D006297:Health Services Accessibility; D006801:Humans; D062409:Lunch; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D008986:Mongolia; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D015397:Program Evaluation; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D014838:Volunteers; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents