Cohort analysis of directly observed treatment outcomes for tuberculosis patients in urban Pakistan
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
(2011). Cohort analysis of directly observed treatment outcomes for tuberculosis patients in urban Pakistan. International Journal of Tuberculosis and Lung Disease, 15(1), 90-96.
Available at: http://ecommons.aku.edu/pakistan_fhs_mc_med_med/18