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Association between Directly Observed Therapy and Treatment Outcomes in Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis

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  • Jia Yin
  • Jinqiu Yuan
  • Yanhong Hu
  • Xiaolin Wei

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) represents a major obstacle towards successful TB control. Directly observed therapy (DOT) was recommended by WHO to improve adherence and treatment outcomes of MDR-TB patients, however, the effectiveness of DOT on treatment outcomes of MDR-TB patients was mixed in previous studies. We conducted this systematic review and meta-analysis to assess the association between DOT and treatment outcomes and to examine the impact of different DOT providers and DOT locations on successful treatment outcomes in MDR-TB patients. Methods: We searched studies published in English between January 1970 and December 2015 in major electronic databases. Two reviewers independently screened articles and extracted information of DOT, treatment success rate and other characteristics of studies. Random effects model was used to calculate the pooled treatment success rate and 95% confidence interval (CI). Sub-group analyses were conducted to access factors associated with successful treatment outcomes. Results: A total of 31 articles 7,466 participants were included. Studies reporting full DOT (67.4%, 95% CI: 61.4–72.8%) had significantly higher pooled treatment success rates than those reporting self-administration therapy (46.9%, 95% CI: 41.4–52.4%). No statistically difference was found among DOT provided by healthcare providers (65.8%, 95% CI: 55.7–74.7%), family members (72.0%, 95% CI: 31.5–93.5%) and private DOT providers (69.5%, 95% CI: 57.0–79.7%); and neither did we find significantly difference on pooled treatment success rates between patients having health facility based DOT (70.5%, 95% CI: 61.5–78.1%) and home-based DOT (68.4%, 95% CI: 51.5–81.5%). Conclusion: Providing DOT for a full course of treatment associated with a higher treatment success rate in MDR-TB patients.

Suggested Citation

  • Jia Yin & Jinqiu Yuan & Yanhong Hu & Xiaolin Wei, 2016. "Association between Directly Observed Therapy and Treatment Outcomes in Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 11(3), pages 1-14, March.
    • Handle: RePEc:plo:pone00:0150511
    DOI: 10.1371/journal.pone.0150511
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    References listed on IDEAS

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    1. Shin, Sonya & Furin, Jennifer & Bayona, Jaime & Mate, Kedar & Kim, Jim Yong & Farmer, Paul, 2004. "Community-based treatment of multidrug-resistant tuberculosis in Lima, Peru: 7 years of experience," Social Science & Medicine, Elsevier, vol. 59(7), pages 1529-1539, October.
    2. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    3. Thelma E Tupasi & Rajesh Gupta & Ma Imelda D Quelapio & Ruth B Orillaza & Nona Rachel Mira & Nellie V Mangubat & Virgil Belen & Nida Arnisto & Lualhati Macalintal & Michael Arabit & Jaime Y Lagahid & , 2006. "Feasibility and Cost-Effectiveness of Treating Multidrug-Resistant Tuberculosis: A Cohort Study in the Philippines," PLOS Medicine, Public Library of Science, vol. 3(9), pages 1-10, September.
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    1. Erika Mohr & Leigh Snyman & Zodwa Mbakaz & Judy Caldwell & Virginia DeAzevedo & Yulene Kock & Laura Trivino Duran & Emilie Venables, 2018. "“Life continues”: Patient, health care and community care workers perspectives on self-administered treatment for rifampicin-resistant tuberculosis in Khayelitsha, South Africa," PLOS ONE, Public Library of Science, vol. 13(9), pages 1-16, September.
    2. Erika Mohr & Johnny Daniels & Busisiwe Beko & Petros Isaakidis & Vivian Cox & Sarah Jane Steele & Odelia Muller & Leigh Snyman & Virginia De Azevedo & Amir Shroufi & Laura Trivino Duran & Jennifer Hug, 2017. "DOT or SAT for Rifampicin-resistant tuberculosis? A non-randomized comparison in a high HIV-prevalence setting," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-13, May.

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