Table 1. Key characteristics of the eight studies included in the systematic review of decentralized versus centralized care for multidrug-resistant tuberculosis, 1994–2013.
Author, year, location | Study design | Year of intervention | Sample size for intervention/control | HIV prevalence in study population (%) | Description of arms |
Method of selection of intervention group | Timing of intervention |
Outcomes measured | ||
---|---|---|---|---|---|---|---|---|---|---|
Control | Intervention | Within treatment | Relative to control | |||||||
Loveday et al.22 2015, KwaZulu-Natal, South Africa | Prospective cohort | 2008–2010 | 736/813 | 75 | Treatment in central specialized tuberculosis hospital | Treatment in rural hospital followed by outpatient home- or clinic-based DOT, by health workers | Based on residential location | Intensive phasea | Concurrent | Death, loss to follow-up, treatment failure, treatment success |
Chan et al.19 2013, Taiwan, China | Retrospective cohort | 2007–2008 | 290/361 | 0.9 | Hospital and out-patient clinics | Home- based DOT, by observers and nurses | Time period | Entire duration of treatment | Consecutive | Treatment success |
Kerschberger et al.b 2016, Swaziland | Retrospective cohort | 2008–2013 | 157/298 | 81 | Clinic-based care in which patients visited nearest health facility daily | Home-based DOT, by trained community volunteers | Based on residential location and socioeconomic status | Intensive phase | Concurrent | Cost of care, death, loss to follow-up, treatment failure, treatment success |
Narita et al.24 2001, Florida, USA | Retrospective cohort | 1994–1997 | 31/39 | 44.3 | Treatment in specialized tuberculosis hospital | Outpatient DOT and/or SAT | Selected for control if: failing treatment, needed treatment of other medical condition and/or non-adherent | Entire duration of treatment | Concurrent | Death, treatment completion |
Gler et al.21 2012, Philippines | Retrospective cohort | 2003–2006 | 167/416 | NR | Treatment in central hospital | Community- based DOT, by trained health-care workers | Time period | After sputum-culture conversion | Consecutive | Loss to follow-up |
Cox et al.20 2014, Khayelitsha, South Africa | Retrospective cohort | 2008–2010 | 512/206 | 72 | Hospital-based care | Community-based care integrated into existing primary care tuberculosis and HIV services. | Based on residential location | Entire duration of treatment | Consecutive | Death, loss to follow-up, treatment failure, treatment success |
Musa et al.23 2016, Nigeria | Modelling | N/A | N/A | NR | Hospital-based care | Home-based DOT, by trained health-care providers | Random selection | Intensive phase | N/A | Health-system costs |
Sinanovic et al.25 2015, Khayelitsha, South Africa | Modelling | N/A | 467c | 72 | Fully hospitalized model in which patients stay in hospital until culture conversion | A model of fully decentralized care in primary health-care clinics, plus other models of partially decentralized care | N/A | Entire duration of treatment | N/A | Health-system costs |
DOT: directly observed therapy; HIV: human immunodeficiency virus; N/A: not applicable; NR: not reported; SAT: self-administered therapy; USA: United States of America.
a Intensive phase defined by inclusion of an injectable antibiotic in the treatment regimen.
b Unpublished study from Médecins Sans Frontières, Mbabane, Swaziland, 2016.
c Total number of patients used in four different models of multidrug-resistant tuberculosis care.