Directly observed therapy for treating tuberculosis.

Volmink, J and Garner, P (2001) Directly observed therapy for treating tuberculosis. The Cochrane database of systematic reviews (4). CD003343-.

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Abstract

<h4>Background</h4>Up to half the people with tuberculosis do not complete their treatment. Strategies to improve adherence to diagnostic and treatment regimens are therefore important.<h4>Objectives</h4>To assess the effects of directly observed therapy by an appointed agent (health worker, community volunteer, or family member) on cure and treatment completion in people on treatment for tuberculosis.<h4>Search strategy</h4>We searched The Cochrane Controlled Trials Register, the Cochrane Infectious Diseases Group specialized trials register, MEDLINE, EMBASE, LILACS, and reference lists of articles. We also contacted experts in the field.<h4>Selection criteria</h4>Randomized and quasi-randomized trials of direct observation of tablet swallowing compared with self treatment for tuberculosis.<h4>Data collection and analysis</h4>Two reviewers independently assessed trial quality and extracted data.<h4>Main results</h4>Four studies (n = 1603 participants) included. There was no difference detected between direct observation and self treatment for cure (Relative Risk [RR] 1.06, 95% confidence interval [CI] 0.98 to 1.14); and for cure plus treatment completion (RR 1.06, 95% CI 1.00 to 1.13). A stratified analysis by the appointed agent (health professional, lay health worker, or family/community member) did not reveal any important differences. One study conducted in an optimal setting in which patients were given a choice of supervisor did show modest benefit: cure (RR 1.13, 95% CI 1.04 to 1.24); cure plus treatment completion (RR 1.11, 95% CI 1.03 to 1.18).<h4>Reviewer's conclusions</h4>Randomized trials provide no evidence that directly observed therapy in low and middle income country settings improves cure or treatment completion rates in patients with tuberculosis.

Item Type:	Article
Additional Information:	This version first published online: 17th October 2007 in Issue 4, 2007. Full-text for this item only available by clicking on the doi link provided or accessing it from the Cochrane Database of Systematic Reviews website http://www.thecochranelibrary.com. As the Cochrane Reviews are regularly updated as new evidence emergences and in response to feedback, the Cochrane Database of Systematic Reviews should be consulted for the most recent version. The bibliographic information provided in the metadata is for the original electronic version prior to any revision. The item should be cited as : Volmink J, Garner P. Directly observed therapy for treating tuberculosis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003343. DOI: 10.1002/14651858.CD003343.pub3.
Uncontrolled Keywords:	Humans, Tuberculosis, Antitubercular Agents, Directly Observed Therapy, Randomized Controlled Trials as Topic
Subjects:	?? RA0421 ??
Divisions:	Faculty of Health and Life Sciences
Depositing User:	Symplectic Admin
Date Deposited:	14 Aug 2008 11:47
Last Modified:	16 Mar 2024 07:52
DOI:	10.1002/14651858.cd003343
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/735