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Clinical Trial
. 2017 May 18;12(5):e0178054.
doi: 10.1371/journal.pone.0178054. eCollection 2017.

DOT or SAT for Rifampicin-resistant tuberculosis? A non-randomized comparison in a high HIV-prevalence setting

Erika Mohr  1 , Johnny Daniels  1 , Busisiwe Beko  1 , Petros Isaakidis  2 , Vivian Cox  3 , Sarah Jane Steele  4 , Odelia Muller  1 , Leigh Snyman  1 , Virginia De Azevedo  5 , Amir Shroufi  4 , Laura Trivino Duran  1 , Jennifer Hughes  1
Affiliations
Clinical Trial

DOT or SAT for Rifampicin-resistant tuberculosis? A non-randomized comparison in a high HIV-prevalence setting

Erika Mohr et al. PLoS One. .

Abstract

Background: Daily directly-observed therapy (DOT) is recommended for rifampicin-resistant tuberculosis (RR-TB) patients throughout treatment. We assessed the impact of self-administered treatment (SAT) in a South African township with high rates of RR-TB and HIV.

Methods: Community-supported SAT for patients who completed the intensive phase was piloted in five primary care clinics in Khayelitsha. We compared final treatment outcomes among RR-TB patients initiating treatment before (standard-of-care (SOC)-cohort, January 2010-July 2013) and after the implementation of the pilot (SAT-cohort, January 2012-December 2014). All patients with outcomes before January 1, 2017 were considered in the analysis of outcomes.

Results: One-hundred-eighteen patients in the SOC-cohort and 174 patients in the SAT-cohort had final RR-TB treatment outcomes; 70% and 73% were HIV-co-infected, respectively. The proportion of patients with a final outcome of loss to follow-up (LTFU) did not differ whether treated in the SOC (25/118, 21.2%) or SAT-cohort (31/174, 17.8%) (P = 0.47). There were no significant differences in the time to 24-month LTFU among HIV-infected and uninfected patients (HR 0.90, 95% CI: 0.51-1.6, P = 0.71), or among patients enrolled in the SOC-cohort versus the SAT-cohort (HR 0.83, 95% CI: 0.49-1.4, P = 0.50) who received at least 6-months of RR-TB treatment.

Conclusion: The introduction of SAT during the continuation phase of RR-TB treatment does not adversely affect final RR-TB treatment outcomes in a high TB and HIV-burden setting. This differentiated, patient-centred model of care could be considered in RR-TB programmes to decrease the burden of DOT on patients and health facilities.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Outline of activities included in the SAT pilot programme.
Fig 2
Fig 2. Patient eligibility for SAT among patients initiating RR-TB treatment from January 2010 through July 2013 in the SOC-cohort and January 2012 through December 2014 in the SAT-cohort.
Fig 3
Fig 3. Loss to follow-up by 24-months among patients who completed at least 6-monts of treatment in the SOC versus SAT-cohorts (p = 0.50).
See this image and copyright information in PMC

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