Community-based directly observed therapy is effective and results in better treatment outcomes for patients with multi-drug resistant tuberculosis in Uganda
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Date
2023-11
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Abstract
Background Health facility-based directly observed therapy (HF DOT) is the main strategy for the management
of patients with drug-resistant tuberculosis (DR TB) in Uganda, however, this still yields sub-optimal treatment out‑
comes. We set out to assess the efectiveness of community-based directly observed therapy (CB DOT) for the treat‑
ment of DR TB in Uganda.
Methods Using a previously developed patient-centered model for CB DOT, we assigned community health workers
(CHWs) as primary caregivers to patients diagnosed with DR TB. CHWs administered daily DOT to patients in their
homes. Once a month, patients received travel vouchers to attend clinic visits for treatment monitoring. We assessed
the efectiveness of this model using a quasi-experimental pre and post-study. From December 2020 to March 2022,
we enrolled adult DR-TB patients on the CB DOT model. We collected retrospective data from patients who had
received care using the HF DOT model during the year before the study started. The adjusted efect of CB DOT ver‑
sus HF DOT on DR TB treatment success was estimated using modifed Poisson regression model with robust cluster
variance estimator.
Results We analyzed data from 264 DR TB patients (152 HF DOT, 112 CB DOT). The majority were males (67.8%)
with a median age of 36 years (IQR 29 to 44 years). Baseline characteristics were similar across the comparison groups,
except for educational level, regimen type, and organizational unit with age being borderline. The treatment suc‑
cess rate in the CB DOT group was 12% higher than that in the HF DOT (adjusted prevalence ratio (aPR)= 1.12 [95%CI
1.01, 1.24], P-value=0.03). Males were less likely to achieve treatment success compared to their female counterparts
(aPR=0.87 [95% CI 0.78, 0.98], P-value=0.02). A total of 126 (47.7%) of 264 patients reported at least one adverse
event. The HF DOT group had a higher proportion of patients with at least one adverse event compared to the CB
DOT group (90/152 [59.2%] versus 36/112 [32.1], P-value<0.01). The model was acceptable among patients (93.6%)
and health workers (94.1%).
Conclusions CB DOT for DR-TB care is efective and results in better treatment outcomes than HF DOT. The costefectiveness of this model of care should be further evaluated.
Description
Keywords
Community-based care, Health facility-based care, Directly observed therapy, Treatment outcomes, Drugresistant TB, Uganda
Citation
Makabayi-Mugabe, Rita, Joseph Musaazi, Stella Zawedde-Muyanja, et al. 'Community-Based Directly Observed Therapy is Effective and Results in Better Treatment Outcomes for Patients with Multi-Drug Resistant Tuberculosis in Uganda', BMC Health Services Research, vol. 23/no. 1, (2023), pp. 1-1248.