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Free Content Community DOT for tuberculosis in a Brazilian favela: comparison with a clinic model

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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.

Keywords: DOT; community; community health workers; treatment success; tuberculosis

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: 2007-05-01

More about this publication?
  • 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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