title: Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Poor adherence to tuberculosis (TB) treatment can lead to prolonged infectivity and poor treatment outcomes. Directly observed treatment (DOT) seeks to improve adherence to TB treatment by observing patients while they take their anti-TB medication. Although community-based DOT (CB-DOT) programs have been widely studied and promoted, their effectiveness has been inconsistent. The aim of this study was to critical appraise and summarize evidence of the effects of CB-DOT on TB treatment outcomes.
  
  
  METHODS
  Studies published up to the end of February 2015 were identified from three major international literature databases: Medline/PubMed, EBSCO, and EMBASE. Unpublished data from the grey literature were identified through Google and Google Scholar searches.
  
  
  RESULTS
  Seventeen studies involving 12,839 pulmonary TB patients (PTB) in eight randomized controlled trials (RCTs) and nine cohort studies from 12 countries met the criteria for inclusion in this review and 14 studies were included in meta-analysis. Compared with clinic-based DOT, pooled results of RCTs for all PTB cases (including smear-negative or -positive, new or retreated TB cases) and smear-positive PTB cases indicated that CB-DOT promoted successful treatment [pooled RRs (95%CIs): 1.11 (1.02-1.19) for all PTB cases and 1.11 (1.02-1.19) for smear-positive PTB cases], and completed treatment [pooled RRs (95%CIs): 1.74(1.05, 2.90) for all PTB cases and 2.22(1.16, 4.23) for smear-positive PTB cases], reduced death [pooled RRs (95%CIs): 0.44 (0.26-0.72) for all PTB cases and 0.39 (0.23-0.66) for smear-positive PTB cases], and transfer out [pooled RRs (95%CIs): 0.37 (0.23-0.61) for all PTB cases and 0.42 (0.25-0.70) for smear-positive PTB cases]. Pooled results of all studies (RCTs and cohort studies) with all PTB cases demonstrated that CB-DOT promoted successful treatment [pooled RR (95%CI): 1.13 (1.03-1.24)] and curative treatment [pooled RR (95%CI): 1.24 (1.04-1.48)] compared with self-administered treatment.
  
  
  CONCLUSIONS
  CB-DOT did improved TB treatment outcomes according to the pooled results of included studies in this review. Studies on strategies for implementation of patient-centered and community-centered CB-DOT deserve further attention.
authors: College of Preventive Medicine, Third Military Medical University, Chongqing, China.
authors: HaiYang
authors: H
authors: Zhang
authors: Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America.
authors: John
authors: J
authors: Ehiri
authors: Department of Hygienic Toxicology, Key Lab of Medical Protection for Electromagnetic Radiation, Ministry of Education of China, Third Military Medical University, China.
authors: Huan
authors: H
authors: Yang
authors: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors: Shenglan
authors: S
authors: Tang
authors: Department of Social Medicine and Health Service Management, College of Preventive Medicine, Third Military Medical University, Chongqing, China.
authors: Ying
authors: Y
authors: Li
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D023801:Directly Observed Therapy / Q000379:methods; D006801:Humans; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents