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Open Access Highly Accessed Research article

Treatment outcomes from community-based drug resistant tuberculosis treatment programs: a systematic review and meta-analysis

Pamela Weiss1, Wenjia Chen2, Victoria J Cook34 and James C Johnston34*

Author Affiliations

1 School of Humanitarian Studies, Royal Roads University, 2005 Sooke Rd, Victoria, British Columbia

2 Collaboration for Outcomes Research and Evaluation, University of British Columbia, 2405 Wesbrook Mall, Vancouver, Canada

3 Division of Respirology, University of British Columbia, Vancouver, Canada

4 The British Columbia Center for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z4R4, Canada

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BMC Infectious Diseases 2014, 14:333  doi:10.1186/1471-2334-14-333

Published: 17 June 2014

Abstract

Background

There is increasing evidence that community-based treatment of drug resistant tuberculosis (DRTB) is a feasible and cost-effective alternative to centralized, hospital-based care. Although several large programs have reported favourable outcomes from community-based treatment, to date there has been no systematic assessment of community-based DRTB treatment program outcomes. The objective of this study was to synthesize available evidence on treatment outcomes from community based multi-drug resistant (MDRTB) and extensively drug resistant tuberculosis (XDRTB) treatment programs.

Methods

We performed a systematic review and meta-analysis of the published literature to examine treatment outcomes from community-based MDRTB and XDRTB treatment programs. Studies reporting outcomes from programs using community-based treatment strategies and reporting outcomes consistent with WHO guidelines were included for analysis. Treatment outcomes, including treatment success, default, failure, and death were pooled for analysis. Meta-regression was performed to examine for associations between treatment outcomes and program or patient factors.

Results

Overall 10 studies reporting outcomes on 1288 DRTB patients were included for analysis. Of this population, 65% [95% CI 59-71%] of patients had a successful outcome, 15% [95% CI 12-19%] defaulted, 13% [95% CI 9-18%] died, and 6% [95% CI 3-11%] failed treatment for a total of 35% [95% CI 29-41%] with unsuccessful treatment outcome. Meta-regression failed to identify any factors associated with treatment success, including study year, age of participants, HIV prevalence, XDRTB prevalence, treatment regimen, directly observed therapy (DOT) location or DOT provider.

Conclusions

Outcomes of community-based MDRTB and XDRTB treatment outcomes appear similar to overall treatment outcomes published in three systematic reviews on MDRTB therapy. Work is needed to delineate program characteristics associated with improved treatment outcomes.

Keywords:
Tuberculosis; Multidrug-resistant; Treatment; Community based