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Free Content A randomised controlled trial of lay health workers as direct observers for treatment of tuberculosis

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SETTING: Study conducted in a suburb of Cape Town, South Africa.

OBJECTIVE: Comparison of successful tuberculosis treatment outcome rates between self supervision, supervision by lay health worker (LHW), and supervision by clinic nurse.

METHODS: Open, randomised, controlled trial with intention-to-treat analysis.

RESULTS: All groups (n = 156) achieved similar outcomes (LHW vs. clinic nurse: risk difference 17.2%, 95% confidence interval [CI] −0.1–34.5; LHW vs. self supervision 15%, 95%CI −3.7–33.6). New patients benefit from LHW supervision (LHW vs clinic nurse: risk difference 24.2%, 95%CI 6– 42.5, LHW vs. self supervision 39.1%, 95%CI 17.8–60.3) as do female patients (LHW vs. clinic nurse 48.3%, 95%CI 22.8–73.8, LHW vs. self supervision 32.6%, 95%CI 6.4–58.7).

CONCLUSIONS: LHW supervision approaches statistically significant superiority, but fails to reach it most likely due to the study's limitation, the small sample size. It is possible that subgroups (new and female patients) do well under LHW supervision. LHW supervision could be offered as one of several supervision options within TB control programmes.
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Keywords: directly observed therapy; randomised controlled trial; treatment outcome; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Health Systems Division, Medical Research Council, Tygerberg, South Africa 2: Health Systems Division, Medical Research Council, Tygerberg, South Africa; and Department of Health, North West Province, South Africa 3: Centre for Epidemiological Research in Southern Africa, Medical Research Council, South Africa 4: Cape Metropolitan Council, South Africa

Publication date: 2000-06-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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