Cavalcante S C, Soares E C C, Pacheco A G F, Chaisson R E, Durovni B
Tuberculosis Control Program, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, Rio de Janeiro, Brazil.
Int J Tuberc Lung Dis. 2007 May;11(5):544-9.
Rio de Janeiro City, Brazil.
To compare community-based directly observed treatment (DOT) for tuberculosis (TB), using community health workers (CHWs), with clinic-based DOT.
In a longitudinal study in a cohort of TB patients in a region of Rio de Janeiro city, we evaluated treatment modalities and outcomes in 1811 patients diagnosed with TB between 1 January 2003 and 30 December 2004. Patients were offered DOT when they presented to out-patient clinics for an initial diagnosis. DOT was provided in the clinic or in the community, using CHWs, for patients living in a large favela. Outcomes of treatment were assessed using treatment registry databases.
Of the 1811 TB patients, 1215 (67%) were treated under DOT; among these, 726 (60%) received clinic-based treatment and 489 (40%) community-based treatment. Patients offered community-based treatment were more likely to accept DOT (99%) than those offered clinic-based treatment (60%, P<0.001). Treatment success rates for new smear-positive and retreatment TB cases were significantly higher among those treated with community-based DOT compared to clinic-based DOT.
We conclude that using CHWs to deliver DOT in the community may improve TB treatment outcomes in selected areas such as urban slums.
巴西里约热内卢市。
比较利用社区卫生工作者在社区开展的肺结核直接督导下的治疗（DOT）与在诊所开展的DOT。
在里约热内卢市一个地区的一组肺结核患者中进行的一项纵向研究中，我们评估了2003年1月1日至2004年12月31日期间确诊的1811例肺结核患者的治疗方式和结局。患者初次到门诊诊断时可选择DOT。对于居住在一个大型贫民窟的患者，在诊所或利用社区卫生工作者在社区提供DOT。利用治疗登记数据库评估治疗结局。
1811例肺结核患者中，1215例（67%）接受了DOT治疗；其中，726例（60%）接受了基于诊所的治疗，489例（40%）接受了基于社区的治疗。接受基于社区治疗的患者比接受基于诊所治疗的患者更有可能接受DOT（99%对60%，P<0.001）。与基于诊所的DOT相比，基于社区的DOT治疗新涂片阳性和复治肺结核病例的治疗成功率显著更高。
我们得出结论，在城市贫民窟等特定地区利用社区卫生工作者在社区提供DOT可能会改善肺结核治疗结局。
