Community- vs. hospital-based management of multidrug-resistant TB in Pakistan

• Published in: The international journal of tuberculosis and lung disease Vol. 26; no. 10; pp. 929 - 933
• Main Authors: Fatima, R., Yaqoob, A., Qadeer, E., Khan, M. A., Ghafoor, A., Jamil, B., Haq, M. U., Ahmed, N., Baig, S., Rehman, A., Abbasi, Q., Khan, A. W., Ikram, A., Hicks, J. P., Walley, J.
• Format: Journal Article
• Language: English
• Published: Paris International Union Against Tuberculosis and Lung Disease 01-10-2022; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Ambulatory; Capitation; Community-Based; Hospital-Based Management; Multidrug resistance; Multidrug resistant organisms; Multidrug-Resistant; Pakistan; Patients; Tuberculosis; Pakistan
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.21.0695

BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group,
superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care
(2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected
sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear
evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based
care model, as recommended by the WHO.