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

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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 [RR(adj)] 1.85, 95%CI 1.43-2.39) than those on family DOT, as were Patients satisfied with their health care worker's attitude (RR(adj) 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.


International Journal of Tuberculosis and Lung Disease