Community DOT for tuberculosis in a Brazilian favela: comparison with a clinic model
Abstract: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.
Document Type: Regular Paper
Affiliations: 1: Tuberculosis Control Program, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, Rio de Janeiro, Brazil; and Evandro Chagas Research Institute (IPEC)/Oswaldo Cruz Foundation, Rio de Janeiro, Brazil 2: Tuberculosis Control Program, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, Rio de Janeiro, Brazil 3: Tuberculosis Control Program, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, Rio de Janeiro, Brazil; and National School of Public Health (ENSP)/Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil 4: Center for Tuberculosis Research, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 5: Rio de Janeiro City TB Control Program, Rio de Janeiro City, Brazil; and Johns Hopkins Center for TB Research, Baltimore, Maryland
Publication date: May 1, 2007
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