Treatment outcomes among tuberculosis patients in Jeddah, Saudi Arabia: Results of a community mobile outreach directly observed Treatment, Short-course (DOTS) project, compared to a standard facility-based DOTS: A randomized controlled trial

Abdullah Al-Sahafi, Mashal M Al-Sayali, Najlaa Mandoura, Hassan B U Shah, Khalid Al Sharif, Emad L Almohammadi, Ola A Abdul-Rashid, Muhammad Assiri, Mohammed F Buksh, Mahmoud M Alali, Abdullah Al-Garni, Fatima Al-Garni, Abdullah Al-Zahrani, Alaa Khalawi, Maha Alawi, Abdulhamed L Moawwad, Abdulrahim I A Almalki, Maataug M Al-Osaimi, Abdullah Al-Sahafi, Mashal M Al-Sayali, Najlaa Mandoura, Hassan B U Shah, Khalid Al Sharif, Emad L Almohammadi, Ola A Abdul-Rashid, Muhammad Assiri, Mohammed F Buksh, Mahmoud M Alali, Abdullah Al-Garni, Fatima Al-Garni, Abdullah Al-Zahrani, Alaa Khalawi, Maha Alawi, Abdulhamed L Moawwad, Abdulrahim I A Almalki, Maataug M Al-Osaimi

Abstract

Introduction: Tuberculosis (TB) remains a global public health threat affecting people in many developing countries, including the Kingdom of Saudi Arabia. Maintaining a long-term treatment regimen has always been the cornerstone of successful treatment outcomes among tuberculosis patients. In the Jeddah region, the National Tuberculosis Control and Prevention Program is now treating TB patients by means of a community mobile outreach team approach.The objective of this study was to compare the effectiveness of the community mobile outreach approach in improving treatment outcomes (success rate) among local tuberculosis patients with those being treated with a facility-based directly observed treatment, short-course (DOTS).

Study design: Our study consisted of a two-sample, parallel design [1:1], statistician -blind randomized control trial with 200 newly diagnosed, TB patients as subjects.

Setting/participants: The patients had all presented at the Madain Alfahd Primary Health Care Center, Jeddah. Between Nov 2017 and Nov 2018, a total of 221 TB patients were screened of whom 200 were randomly selected using randomly generated sequences.

Intervention: Patients in the intervention sample group were treated by means of mobile outreach teams with oral anti-TB treatment under the DOTS, and control group patients were given the traditional facility-based DOTS treatment according to the WHO recommendations and national guidelines.

Main outcome: The primary outcome was the level of overall treatment success rate. It was finally determined and compared in the two sample groups using chi-square analysis and relative risk assessment.

Results: In the analysis stage, 97 patients were in the intervention group, while the control group consisted of 76. The overall response rate was 86.5% (173/200). We found that the percentage of overall treatment success rate among the patients served by the mobile outreach team was 97%, compared to 76% in the non-mobile team treated patients. The relative risk of treatment success rate among the intervention group was 1.27 (95% CI = 1.13-1.43) times greater than that amongst the control group. Log-rank test (log-rank statistics = 18.91; p < 0.001) identified a significant difference in the default rate after six months of treatment.

Conclusion: This study has shown that a mobile outreach DOTS approach is an effective and acceptable strategy for treating TB patients. It also provides important data on the efficacy of using mobile outreach teams to improve TB treatment outcomes in Jeddah. Our results provide evidence and highlight the positive and significant impact of mobile outreach teams in mitigating TB recurrence rates and in improving TB treatment outcomes.Clinical Trial Registration: Clinicaltrials.gov: NCT03787914.

Keywords: Community outreach; Default; Directly observed treatment; Impact; Mobile outreach teams; Randomized controlled trial; Short-course (DOTS); Success; Treatment outcome; Tuberculosis.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

© 2020 The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart from the recruitment to the completion of the follow-up of the participants.
Fig. 2
Fig. 2
Treatment outcome of intervention and control groups.
Fig. 3
Fig. 3
Kaplan-Meier plot of the six months treatment duration.

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