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An Automated Culture System for Use in Preclinical Testing of Host-Directed Therapies for Tuberculosis
Published on: August 16, 2021
Success of community-based directly observed anti-tuberculosis treatment in Mongolia
C C Dobler1, S Korver2, O Batbayar3
1National Health and Medical Research Council Centre of Research Excellence in Tuberculosis Control, University of Sydney, Sydney, Australia; Department of Respiratory Medicine, Liverpool Hospital and South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
Background:
Many countries restrict access to directly observed therapy (DOT) for tuberculosis (TB) to government health facilities. More innovative approaches are required to reduce non-adherence, improve patient outcomes and limit the risk of selecting drug-resistant strains.
Methods:
We performed a retrospective cohort study in sputum smear-positive patients treated with community-based DOT (home-based DOT or 'lunch' DOT, whereby DOT is provided with a free daily meal once sputum smear conversion has been documented), and conventional clinic-based DOT in Ulaanbaatar, the capital of Mongolia, in 2010-2011. We compared treatment success using community-based home DOT vs. conventional clinic DOT and describe treatment completion rates using lunch DOT.
Results:
The overall treatment success among new sputum smear-positive TB patients was 85.1% (1505/1768). Patients receiving community DOT had higher cure rates (294/327, 89.9% vs. 1112/1441, 77.2%; aOR 2.66, 95%CI 1.81-3.90) and higher treatment success (306/327, 93.6% vs. 1199/1441, 83.2%; aOR 2.95, 95%CI 1.85-4.71, P < 0.001) than those treated with clinic DOT. Apart from one death, treatment completion was 100% among patients who received lunch DOT after sputum smear conversion.
Conclusions:
Community DOT improved treatment success in Ulaanbaatar, Mongolia. It should now be scaled up to be made available for more patients and in all regions of the country.
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