Evidence map›Paper›PMID 25574914›Full record

ArticleThe international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease2015

Community-based care vs. centralised hospitalisation for MDR-TB patients, KwaZulu-Natal, South Africa.

M Loveday, K Wallengren, J Brust, J Roberts, A Voce, B Margot, J Ngozo, I Master, G Cassell, N Padayatchi

Open access · greenAbstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 9 pooled it
8.2field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 9 syntheses or guidelines pooled it, 104 citations in OpenAlex.

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  5. Time to treatment for rifampicin-resistant tuberculosis: systematic review and meta-analysis.The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2017
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  7. Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2017
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 3 countries.

M LovedayHealth Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
K WallengrenTB and HIV Investigative Network (Think), Durban, South Africa.
J BrustDepartment of Medicine, Montefiore Medical Center & Albert Einstein College of Medicine, New York, New York, USA.
J RobertsCenters for Disease Control and Prevention, Atlanta, Georgia, USA.
A VoceDiscipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.
B MargotKwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
J NgozoKwaZulu-Natal Department of Health, Pietermaritzburg, South Africa.
I MasterKing Dinuzulu Hospital, Durban, South Africa.
G CassellHarvard University School of Medicine, Boston, Massachusetts, USA.
N PadayatchiCentre for the AIDS Programme of Research in South Africa, Durban, South Africa.
Centers for Disease Control and Prevention · UGAlbert Einstein College of Medicine · USCentre for the AIDS Programme of Research in South Africa · ZAHarvard University · USSouth African Medical Research Council · ZAUniversity of KwaZulu-Natal · ZA

Funding

TUBERCULOSIS SUPPLEMENTD43TW000231 · FIC · COLUMBIA UNIV NEW YORK MORNINGSIDE · PI ABDOOL KARIM, QUARRAISHA · 1993 to 2014
$13.1M
Integrated, Home-based Treatment for MDR TB and HIV in Rural South AfricaK23AI083088 · NIAID · ALBERT EINSTEIN COLLEGE OF MEDICINE, INC · PI BRUST, JAMES C M · 2010 to 2014
$665k
FIC NIH HHS D43 TW000231FIC NIH HHS D43TW00231NIAID NIH HHS K23 AI083088NIAID NIH HHS K23AI083088
6 · The paper itself

Abstract

settingKwaZulu-Natal, South Africa, a predominantly rural province with a high burden of tuberculosis (TB), multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection.

objectiveTo determine the most effective care model by comparing MDR-TB treatment outcomes at community-based sites with traditional care at a central, specialised hospital.

designA non-randomised observational prospective cohort study comparing community-based and centralised care. Patients at community-based sites were closer to home and had easier access to care, and home-based care was available from treatment initiation.

resultsFour community-based sites treated 736 patients, while 813 were treated at the centralised hospital (total = 1549 patients). Overall, 75% were HIV co-infected (community: 76% vs. hospitalised: 73%, P = 0.45) and 86% received antiretroviral therapy (community: 91% vs. hospitalised: 82%, P = 0.22). On multivariate analysis, MDR-TB patients were more likely to have a successful treatment outcome if they were treated at a community-based site (adjusted OR 1.43, P = 0.01). However, outcomes at the four community-based sites were heterogeneous, with Site 1 demonstrating that home-based care was associated with an increased treatment success of 72% compared with success rates of 52-60% at the other three sites.

conclusionCommunity-based care for MDR-TB patients was more effective than care in a central, specialised hospital. Home-based care further increased treatment success.

Indexed as

HospitalizationAdultAnti-HIV AgentsAntitubercular AgentsCohort StudiesCommunity Health ServicesFemaleHealth Services AccessibilityHIV InfectionsHome Care ServicesHumansMaleModels, TheoreticalProspective StudiesSouth AfricaTreatment OutcomeAnti-HIV AgentsAntitubercular Agents

Identifiers

PMID25574914
PMCPMC4324454
OpenAlexW2322833691

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.