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Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis.

dc.contributor.author Zhang, HaiYang
dc.contributor.author Ehiri, John
dc.contributor.author Yang, Huan
dc.contributor.author Tang, Shenglan
dc.contributor.author Li, Ying
dc.coverage.spatial United States
dc.date.accessioned 2017-12-01T14:22:28Z
dc.date.available 2017-12-01T14:22:28Z
dc.date.issued 2016
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26849656
dc.identifier PONE-D-15-23296
dc.identifier.uri https://hdl.handle.net/10161/15800
dc.description.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 Unpublished data from the grey literature were identified through Google and Google Scholar searches.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.
dc.language eng
dc.publisher Public Library of Science (PLoS)
dc.relation.ispartof PLoS One
dc.relation.isversionof 10.1371/journal.pone.0147744
dc.subject Antitubercular Agents
dc.subject Directly Observed Therapy
dc.subject Humans
dc.subject Treatment Outcome
dc.subject Tuberculosis
dc.subject Tuberculosis, Pulmonary
dc.title Impact of Community-Based DOT on Tuberculosis Treatment Outcomes: A Systematic Review and Meta-Analysis.
dc.type Journal article
duke.contributor.id Tang, Shenglan|0579184
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26849656
pubs.begin-page e0147744
pubs.issue 2
pubs.organisational-group Basic Science Departments
pubs.organisational-group Duke
pubs.organisational-group Population Health Sciences
pubs.organisational-group School of Medicine
pubs.organisational-group Temp group - logins allowed
pubs.publication-status Published online
pubs.volume 11
dc.identifier.eissn 1932-6203
duke.contributor.orcid Tang, Shenglan|0000-0001-6462-753X


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