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Decentralized care for multidrug-resistant tuberculosis: a systematic review and meta-analysis.
| Content Provider | Europe PMC |
|---|---|
| Author | Ho, Jennifer Byrne, Anthony L Linh, Nguyen N Jaramillo, Ernesto Fox, Greg J |
| Copyright Year | 2017 |
| Abstract | ObjectiveTo assess the effectiveness of decentralized treatment and care for patients with multidrug-resistant (MDR) tuberculosis, in comparison with centralized approaches.MethodsWe searched ClinicalTrials.gov, the Cochrane library, Embase®, Google Scholar, LILACS, PubMed®, Web of Science and the World Health Organization’s portal of clinical trials for studies reporting treatment outcomes for decentralized and centralized care of MDR tuberculosis. The primary outcome was treatment success. When possible, we also evaluated, death, loss to follow-up, treatment adherence and health-system costs. To obtain pooled relative risk (RR) estimates, we performed random-effects meta-analyses.FindingsEight studies met the eligibility criteria for review inclusion. Six cohort studies, with 4026 participants in total, reported on treatment outcomes. The pooled RR estimate for decentralized versus centralized care for treatment success was 1.13 (95% CI: 1.01–1.27). The corresponding estimate for loss to follow-up was RR: 0.66 (95% CI: 0.38–1.13), for death RR: 1.01 (95% CI: 0.67–1.52) and for treatment failure was RR: 1.07 (95% CI: 0.48–2.40). Two of three studies evaluating health-care costs reported lower costs for the decentralized models of care than for the centralized models.ConclusionTreatment success was more likely among patients with MDR tuberculosis treated using a decentralized approach. Further studies are required to explore the effectiveness of decentralized MDR tuberculosis care in a range of different settings. |
| ISSN | 00429686 |
| Journal | Bulletin of the World Health Organization |
| Volume Number | 95 |
| PubMed Central reference number | PMC5537756 |
| Issue Number | 8 |
| PubMed reference number | 28804170 |
| e-ISSN | 15640604 |
| DOI | 10.2471/BLT.17.193375 |
| Language | English |
| Publisher | World Health Organization |
| Publisher Date | 2017-08-01 |
| Access Restriction | Open |
| Rights License | This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL. (c) 2017 The authors; licensee World Health Organization. |
| Content Type | Text |
| Resource Type | Article |
| Subject | Public Health, Environmental and Occupational Health |
