Abstract
BackgroundMultidrug-resistant tuberculosis (MDR-TB) represents a major obstacle towards successful TB control. Directly observed therapy (DOT) was recommended by WHO to improve adherence and treatment outcomes of MDR-TB patients, however, the effectiveness of DOT on treatment outcomes of MDR-TB patients was mixed in previous studies. We conducted this systematic review and meta-analysis to assess the association between DOT and treatment outcomes and to examine the impact of different DOT providers and DOT locations on successful treatment outcomes in MDR-TB patients.MethodsWe searched studies published in English between January 1970 and December 2015 in major electronic databases. Two reviewers independently screened articles and extracted information of DOT, treatment success rate and other characteristics of studies. Random effects model was used to calculate the pooled treatment success rate and 95% confidence interval (CI). Sub-group analyses were conducted to access factors associated with successful treatment outcomes.ResultsA total of 31 articles 7,466 participants were included. Studies reporting full DOT (67.4%, 95% CI: 61.4–72.8%) had significantly higher pooled treatment success rates than those reporting self-administration therapy (46.9%, 95% CI: 41.4–52.4%). No statistically difference was found among DOT provided by healthcare providers (65.8%, 95% CI: 55.7–74.7%), family members (72.0%, 95% CI: 31.5–93.5%) and private DOT providers (69.5%, 95% CI: 57.0–79.7%); and neither did we find significantly difference on pooled treatment success rates between patients having health facility based DOT (70.5%, 95% CI: 61.5–78.1%) and home-based DOT (68.4%, 95% CI: 51.5–81.5%).ConclusionProviding DOT for a full course of treatment associated with a higher treatment success rate in MDR-TB patients.
Highlights
Multidrug-resistant tuberculosis (MDR-TB) was defined as strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, i.e., the two first-line anti-TB drugs [1]
Studies reporting full Directly observed therapy (DOT) (67.4%, 95% confidence interval (CI): 61.4–72.8%) had significantly higher pooled treatment success rates than those reporting self-administration therapy (46.9%, 95% CI: 41.4–52.4%)
No statistically difference was found among DOT provided by healthcare providers (65.8%, 95% CI: 55.7– 74.7%), family members (72.0%, 95% CI: 31.5–93.5%) and private DOT providers (69.5%, 95% CI: 57.0–79.7%); and neither did we find significantly difference on pooled treatment success rates between patients having health facility based DOT (70.5%, 95% CI: 61.5– 78.1%) and home-based DOT (68.4%, 95% CI: 51.5–81.5%)
Summary
Multidrug-resistant tuberculosis (MDR-TB) was defined as strains of Mycobacterium tuberculosis resistant to at least isoniazid and rifampicin, i.e., the two first-line anti-TB drugs [1]. According to World Health Organization’s (WHO) guideline on drugresistance TB management, MDR-TB treatment regimen takes at least 20 months in two treatment phases: the intensive phase and the continuation phase [3]. WHO suggested to use four or more effective second-line anti-TB drugs (including one injectable and three oral drugs) plus pyrazinamide in the eight-month intensive phase, and all the oral in the continuation phase which normally lasts for 12–18 months [3]. Multidrug-resistant tuberculosis (MDR-TB) represents a major obstacle towards successful TB control. Observed therapy (DOT) was recommended by WHO to improve adherence and treatment outcomes of MDR-TB patients, the effectiveness of DOT on treatment outcomes of MDR-TB patients was mixed in previous studies. We conducted this systematic review and meta-analysis to assess the association between DOT and treatment outcomes and to examine the impact of different DOT providers and DOT locations on successful treatment outcomes in MDR-TB patients
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