Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis.
| Autor: | Williams AO; School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane, Piscataway, New Brunswick, 08854 NJ USA.; Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Brunswick, NJ USA., Makinde OA; Viable Knowledge Masters, 22 Olusegun Obasanjo Street, Peace Court Estate, Lokogoma, Abuja Nigeria.; Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa., Ojo M; School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane, Piscataway, New Brunswick, 08854 NJ USA. |
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| Jazyk: | angličtina |
| Zdroj: | Global health research and policy [Glob Health Res Policy] 2016 Aug 02; Vol. 1, pp. 10. Date of Electronic Publication: 2016 Aug 02 (Print Publication: 2016). |
| DOI: | 10.1186/s41256-016-0010-y |
| Abstrakt: | Background: Multidrug drug resistant Tuberculosis (MDR-TB) and extensively drug resistant Tuberculosis (XDR-TB) have emerged as significant public health threats worldwide. This systematic review and meta-analysis aimed to investigate the effects of community-based treatment to traditional hospitalization in improving treatment success rates among MDR-TB and XDR-TB patients in the 27 MDR-TB High burden countries (HBC). Methods: We searched PubMed, Cochrane, Lancet, Web of Science, International Journal of Tuberculosis and Lung Disease, and Centre for Reviews and Dissemination (CRD) for studies on community-based treatment and traditional hospitalization and MDR-TB and XDR-TB from the 27 MDR-TB HBC. Data on treatment success and failure rates were extracted from retrospective and prospective cohort studies, and a case control study. Sensitivity analysis, subgroup analyses, and meta-regression analysis were used to explore bias and potential sources of heterogeneity. Results: The final sample included 16 studies involving 3344 patients from nine countries; Bangladesh, China, Ethiopia, Kenya, India, South Africa, Philippines, Russia, and Uzbekistan. Based on a random-effects model, we observed a higher treatment success rate in community-based treatment (Point estimate = 0.68, 95 % CI: 0.59 to 0.76, p < 0.01) compared to traditional hospitalization (Point estimate = 0.57, 95 % CI: 0.44 to 0.69, p < 0.01). A lower treatment failure rate was observed in community-based treatment 7 % (Point estimate = 0.07, 95 % CI: 0.03 to 0.10; p < 0.01) compared to traditional hospitalization (Point estimate = 0.188, 95 % CI: 0.10 to 0.28; p < 0.01). In the subgroup analysis, studies without HIV co-infected patients, directly observed therapy short course-plus (DOTS-Plus) implemented throughout therapy, treatment duration > 18 months, and regimen with drugs >5 reported higher treatment success rate. In the meta-regression model, age of patients, adverse events, treatment duration, and lost to follow up explains some of the heterogeneity of treatment effects between studies. Conclusion: Community-based management improved treatment outcomes. A mix of interventions with DOTS-Plus throughout therapy and treatment duration > 18 months as well as strategies in place for lost to follow up and adverse events should be considered in MDR-TB and XDR-TB interventions, as they influenced positively, treatment success. |
| Databáze: | MEDLINE |
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