Free Content Cohort analysis of directly observed treatment outcomes for tuberculosis patients in urban Pakistan

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Abstract:

BACKGROUND: This quasi-experimental cohort study aimed to evaluate World Health Organization (WHO) defined tuberculosis (TB) treatment outcomes for patients under directly observed treatment at a health facility (clinic DOT) or at home (family DOT) in urban Pakistan.

METHODS: We enrolled 582 sputum smear-positive TB patients being treated by either clinic DOT (n = 295) or family DOT (n = 287) in 11 treatment centres. Patients and/or family members were interviewed for baseline measurements. WHO-defined treatment outcomes were evaluated at the end of treatment. Proportions of ‘cured’ patients were computed. A log-binomial model was used to evaluate the associations of various factors with ‘cured’ status.

RESULTS: The proportion of ‘cured’ patients was respectively 66% and 34% in the clinic DOT and family DOT groups (risk difference 0.32; 95%CI 0.24–0.39). Patients on clinic DOT were more likely to achieve cure (adjusted relative risk [RRadj] 1.85; 95%CI 1.43–2.39) than those on family DOT, as were patients satisfied with their health care worker’s attitude (RRadj 5.73; 95%CI 2.54–12.96).

CONCLUSION: Clinic DOT nearly doubled the proportion of cured patients compared to family DOT. Efforts to improve care-provider attitudes to enhance patient satisfaction, and effective implementation of the WHO's public-private mix approach, may enhance TB control in this and similar settings.

Keywords: DOT; Pakistan; cure rate; log-binomial regression model; pulmonary tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Community Medicine and Behavioural Sciences, Faculty of Medicine, Kuwait University, Jabriya, Kuwait; Department of Community Health Sciences, Faculty of Medicine, Aga Khan University, Karachi, Pakistan 2: Department of Community Health Sciences, Faculty of Medicine, Aga Khan University, Karachi, Pakistan 3: Department of Community Health Sciences, Faculty of Medicine, Aga Khan University, Karachi, Pakistan; Pacific Health & Development Sciences Inc., Victoria, British Columbia, Canada 4: Department of Pathology and Microbiology, Faculty of Medicine, Aga Khan University, Karachi, Pakistan

Publication date: January 1, 2011

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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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