SETTING: Rio de Janeiro City, Brazil. OBJECTIVE: To compare community-based directly observed treatment (DOT) for tuberculosis (TB), using community health workers (CHWs), with clinic-based DOT. DESIGN: In a longitudinal study in a cohort of TB patients in a region of Rio de Janeiro city, we evaluated treatment modalities and outcomes in 1811 patients diagnosed with TB between 1 January 2003 and 30 December 2004. Patients were offered DOT when they presented to out-patient clinics for an initial diagnosis. DOT was provided in the clinic or in the community, using CHWs, for patients living in a large favela. Outcomes of treatment were assessed using treatment registry databases. RESULTS: Of the 1811 TB patients, 1215 (67%) were treated under DOT; among these, 726 (60%) received clinic-based treatment and 489 (40%) community-based treatment. Patients offered community-based treatment were more likely to accept DOT (99%) than those offered clinic-based treatment (60%, P<0.001). Treatment success rates for new smear-positive and retreatment TB cases were significantly higher among those treated with community-based DOT compared to clinic-based DOT. CONCLUSION: We conclude that using CHWs to deliver DOT in the community may improve TB treatment outcomes in selected areas such as urban slums.
SETTING: Rio de Janeiro City, Brazil. OBJECTIVE: To compare community-based directly observed treatment (DOT) for tuberculosis (TB), using community health workers (CHWs), with clinic-based DOT. DESIGN: In a longitudinal study in a cohort of TB patients in a region of Rio de Janeiro city, we evaluated treatment modalities and outcomes in 1811 patients diagnosed with TB between 1 January 2003 and 30 December 2004. Patients were offered DOT when they presented to out-patient clinics for an initial diagnosis. DOT was provided in the clinic or in the community, using CHWs, for patients living in a large favela. Outcomes of treatment were assessed using treatment registry databases. RESULTS: Of the 1811 TB patients, 1215 (67%) were treated under DOT; among these, 726 (60%) received clinic-based treatment and 489 (40%) community-based treatment. Patients offered community-based treatment were more likely to accept DOT (99%) than those offered clinic-based treatment (60%, P<0.001). Treatment success rates for new smear-positive and retreatment TB cases were significantly higher among those treated with community-based DOT compared to clinic-based DOT. CONCLUSION: We conclude that using CHWs to deliver DOT in the community may improve TB treatment outcomes in selected areas such as urban slums.
Authors: A C Miller; J E Golub; S C Cavalcante; B Durovni; L H Moulton; Z Fonseca; D Arduini; R E Chaisson; E C C Soares Journal: Int J Tuberc Lung Dis Date: 2010-06 Impact factor: 2.373
Authors: Jonathan E Golub; Betina Durovni; Bonnie S King; Solange C Cavalacante; Antonio G Pacheco; Lawrence H Moulton; Richard D Moore; Richard E Chaisson; Valeria Saraceni Journal: AIDS Date: 2008-11-30 Impact factor: 4.177
Authors: L Shah; M Rojas; O Mori; C Zamudio; J S Kaufman; L Otero; E Gotuzzo; C Seas; T F Brewer Journal: Epidemiol Infect Date: 2017-02-06 Impact factor: 4.434
Authors: Edward C Jones-López; Irene Ayakaka; Jonathan Levin; Nancy Reilly; Francis Mumbowa; Scott Dryden-Peterson; Grace Nyakoojo; Kevin Fennelly; Beth Temple; Susan Nakubulwa; Moses L Joloba; Alphonse Okwera; Kathleen D Eisenach; Ruth McNerney; Alison M Elliott; Jerrold J Ellner; Peter G Smith; Roy D Mugerwa Journal: PLoS Med Date: 2011-03-15 Impact factor: 11.069