Effectiveness of directly observed treatment of tuberculosis: a systematic review of controlled studies

BACKGROUND: There is controversy about the effectiveness of directly observed treatment (DOT) for anti-tuberculosis treatment. This systematic review aimed to synthesise evidence from studies that compared DOT and self-administered treatment (SAT) or different types of DOT for anti-tuberculosis treatment.

METHODS: Multiple databases were searched by two independent reviewers to identify relevant randomised (RCTs) and non-randomised studies. The risk of bias was independently assessed by two reviewers, and studies at high risk of bias were excluded. Data extraction was conducted by one reviewer and checked by a second reviewer. Primary outcome measures were cure and treatment success.

RESULTS: We included eight RCTs and 15 non-randomised studies that were predominantly conducted in low- and middle-income countries. There was no convincing evidence that clinic DOT was more effective than SAT. Evidence from both RCTs and non-randomised studies suggested that community DOT was more effective than SAT. Community DOT was as effective as, or more effective than, clinic DOT. There was no statistically significant difference in results between family and non-family community DOT.

CONCLUSIONS: Community DOT by non-family members might be the best option if it is more convenient to patients and less costly to health services than clinic DOT.