Treatment outcomes of patients with drug-sensitive tuberculosis under community-based versus facility-based directly observed treatment, short course strategy in Southwest Ethiopia: a prospective cohort study

Abstract

Objective: To compare tuberculosis (TB) treatment outcomes and associated factors among patients attending community-based versus facility-based directly observed treatment, short course (DOTS).

Design: A prospective cohort study.

Setting: The study was conducted in Southwest Ethiopia. There were seven hospitals (five primary, one general and one specialised), 120 health centres and 494 health posts.

Participants: A total of 1161 individuals consented to participate in the study (387 patients under community-based DOTS (CB-DOTS) and 774 patients under facility-based DOTS (FB-DOTS)). Individuals who could not respond to the questions, mentally or critically ill patients, and those less than 15 years old, were excluded from the study.

Primary outcome measure: TB treatment outcomes were compared among patients under CB-DOTS versus FB-DOTS. Risk ratio (RR), risk difference (RD) and confidence interval (CI) were calculated among the study groups. In addition, χ2 or Fisher’s exact tests were used to compare group differences, with a p value of <0.05 considered statistically significant.

Results: Patients who opted for CB-DOTS were more likely to be cured by 12% than those who opted for FB-DOTS (RR=1.12, 95%CI=0.96 to 1.30). Patients under CB-DOTS had a lesser risk of death (RR=0.93, 95% CI=0.49 to 1.77) and a lower risk of treatment failure (RR=0.86, 95% CI=0.22 to 3.30) than those under FB-DOTS. Furthermore, patients who opted for CB-DOTS were less likely to have a positive sputum smear result at the end of the treatment period (p=0.042) compared with their counterparts.

Conclusion: The study showed that CB-DOTS is more effective than FB-DOTS in terms of improving cure rate and sputum conversion rate, as well as lowering treatment failure rate. Our findings show the need for scaling up and a further decentralisation of CB-DOTS approach to improve access to TB treatment service for the rural community.