title: Community-based directly observed therapy (DOT) versus clinic DOT for tuberculosis: a systematic review and meta-analysis of comparative effectiveness.
abstract: BACKGROUND
  Directly observed therapy (DOT), as recommended by the World Health Organization, is used in many countries to deliver tuberculosis (TB) treatment. The effectiveness of community-based (CB DOT) versus clinic DOT has not been adequately assessed to date. We compared TB treatment outcomes of CB DOT (delivered by community health workers or community volunteers), with those achieved through conventional clinic DOT.
  
  
  METHODS
  We performed a systematic review and meta-analysis of studies before 9 July 2014 comparing treatment outcomes of CB DOT and clinic DOT. The primary outcome was treatment success; the secondary outcome was loss to follow-up.
  
  
  RESULTS
  Eight studies were included comparing CB DOT to clinic DOT, one a randomised controlled trial. CB DOT outperformed clinic DOT treatment success (pooled odds ratio (OR) of 1.54, 95% confidence interval (CI) 1.01 - 2.36, p = 0.046, I(2) heterogeneity 84%). No statistically significant difference was found between the two DOT modalities for loss to follow-up (pooled OR 0.86, 95% CI 0.48 to 1.55, p = 0.62, I(2) 83%).
  
  
  CONCLUSIONS
  Based on this systematic review, CB DOT has a higher treatment success compared to clinic DOT. However, as only one study was a randomised controlled trial, the findings have to be interpreted with caution.
authors.affiliation: Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia. Cameron.wright@utas.edu.au.
authors.forename: Cameron M
authors.initials: CM
authors.lastname: Wright
authors.affiliation: Spectrum Health, Grand Rapids, MI, USA. lmwesterkamp@gmail.com.
authors.forename: Lenna
authors.initials: L
authors.lastname: Westerkamp
authors.affiliation: National Tuberculosis Centre, Thimi, Nepal. skor9113@uni.sydney.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Korver
authors.affiliation: University of Western Sydney, Sydney, NSW, Australia. c.dobler@uws.edu.au.|NHMRC Centre of Research Excellence in Tuberculosis Control, University of Sydney, Sydney, NSW, Australia. c.dobler@uws.edu.au.
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Dobler
mesh_terms: D000554:Ambulatory Care Facilities; D000995:Antitubercular Agents / Q000008:administration & dosage*; D003153:Community Health Services; D003695:Delivery of Health Care; D023801:Directly Observed Therapy / Q000379:methods*; D006801:Humans; D016017:Odds Ratio; D015397:Program Evaluation; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents