title: Does decentralisation of tuberculosis care influence treatment outcomes? The case of Oromia Region, Ethiopia.
abstract: METHODS
  Oromia Region, Ethiopia.
  
  
  OBJECTIVE
  To investigate the effect of decentralised care on anti-tuberculosis treatment outcomes and identify factors affecting outcome among new smear-positive tuberculosis (TB) patients.
  
  
  METHODS
  This was a retrospective cohort study comparing patients treated in the community during the continuation phase with those managed throughout treatment in health facilities. Data were collected from TB registers and patient cards using a pre-tested data capture form.
  
  
  RESULTS
  Of the 2226 new smear-positive TB patients registered from July 2010 to June 2012 who were included in the study, 1599 (72.6%) received treatment in health facilities, and the rest in the community. Overall treatment success was 94.7%. Patients treated in the community had comparable treatment success with those managed in health facilities (aOR 1.7, 95%CI 0.80-3.57). Missing doses (OR 0.22, 95%CI 0.08-0.55), supervision during the continuation phase (OR 2.6, 95%CI 1.34-5.05), positive sputum at month 2 (OR 0.07, 95%CI 0.04-0.13) and human immunodeficiency virus infection (OR 0.25, 95%CI 0.13-0.46) were independent predictors of treatment success.
  
  
  CONCLUSIONS
  Overall treatment success is high in new smear-positive TB patients in Oromia. Patients receiving treatment in the community during the continuation phase have treatment success comparable with that of patients managed in health facilities.
authors.affiliation: Oromia Regional Health Bureau, Addis Ababa, Ethiopia ; World Health Organization Country Office, Addis Ababa, Ethiopia.
authors.forename: K H
authors.initials: KH
authors.lastname: Ketema
authors.affiliation: Oromia Regional Health Bureau, Addis Ababa, Ethiopia.
authors.forename: J
authors.initials: J
authors.lastname: Raya
authors.affiliation: Adama Hospital Medical Collage, Adama, Ethiopia.
authors.forename: T
authors.initials: T
authors.lastname: Workineh
authors.affiliation: KNCV Tuberculosis Foundation, The Hague, The Netherlands ; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Klinkenberg
authors.affiliation: Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: F
authors.initials: F
authors.lastname: Enquselassie
keywords: community-based TB care; health facility; health post; new smear-positive TB; treatment outcome