Fatima, R, Yaqoob, A, Qadeer, E et al. (12 more authors) (2022) Community- vs. hospital-based management of multidrug-resistant TB in Pakistan. The International Journal of Tuberculosis and Lung Disease, 26 (10). pp. 929-933. ISSN 1027-3719
Abstract
BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18–24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.
METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.
RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI –0.02 to 0.15; P = 0.144).
CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Protected by copyright. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Pakistan; ambulatory; community-based; hospital-based management; multidrug-resistant; tuberculosis |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Nuffield Centre for International Health and Development (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 09 Dec 2022 16:11 |
Last Modified: | 01 Apr 2023 00:13 |
Status: | Published |
Publisher: | International Union Against Tuberculosis and Lung Disease |
Identification Number: | 10.5588/ijtld.21.0695 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:193906 |