Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

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Abstract

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.

Related collections

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Author and article information

Contributors

Abimbola Onigbanjo Williams: 732-322-2173 , ao333@sph.rutgers.edu

Olusesan Ayodeji Makinde: +234-8029971000 , sesmak@gmail.com

Mojisola Ojo: mo432@sph.rutgers.edu

Journal

Journal ID (nlm-ta): Glob Health Res Policy

Journal ID (iso-abbrev): Glob Health Res Policy

Title: Global Health Research and Policy

Publisher: BioMed Central (London )

ISSN (Electronic): 2397-0642

Publication date (Electronic): 2 August 2016

Publication date PMC-release: 2 August 2016

Publication date Collection: 2016

Volume: 1

Electronic Location Identifier: 10

Affiliations

[1 ]GRID grid.430387.b, ISNI 0000000419368796, School of Public Health, Rutgers, The State University of New Jersey, ; 683 Hoes Lane, Piscataway, New Brunswick, 08854 NJ USA

[2 ]GRID grid.430387.b, ISNI 0000000419368796, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, ; Piscataway, New Brunswick, NJ USA

[3 ]Viable Knowledge Masters, 22 Olusegun Obasanjo Street, Peace Court Estate, Lokogoma, Abuja Nigeria

[4 ]GRID grid.11951.3d, ISNI 0000000419371135, Demography and Population Studies Program, Schools of Public Health and Social Sciences, University of the Witwatersrand, ; Johannesburg, South Africa

Article

Publisher ID: 10

DOI: 10.1186/s41256-016-0010-y

PMC ID: 5693550

PubMed ID: 29202059

SO-VID: 42a82efa-f5e5-4109-813b-87ec0b9801ce

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 7 April 2016

Date accepted : 25 July 2016

Custom metadata

Keywords: multidrug resistant tuberculosis,extensively drug resistant tuberculosis,community-based treatment,hospitalization,mdr-tb high burden countries

Data availability:

Keywords: multidrug resistant tuberculosis, extensively drug resistant tuberculosis, community-based treatment, hospitalization, mdr-tb high burden countries

Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

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