SynthesisBulletin of the World Health Organization2017
Decentralized care for multidrug-resistant tuberculosis: a systematic review and meta-analysis.
Synthesis in Bulletin of the World Health Organization, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05671718 (Bring BPaL2Me Trial Comparing Nurse-Led RR-TB Treatment in Primary Care to Physician-Led, Hospital-Based Outpatient RR-TB Treatment), which is not on this map. Cited by 42 papers, 2 of them syntheses that pooled 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.
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.
Bring BPaL2Me Trial Comparing Nurse-Led RR-TB Treatment in Primary Care to Physician-Led, Hospital-Based Outpatient RR-TB Treatment: A Cluster Randomized, Non-Inferiority Trial
Who cites it
42 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Interventions to Improve Uptake of Direct-Acting Antivirals for Hepatitis C Virus in Priority Populations: A Systematic Review.Frontiers in public health · 2022Pooled it
- Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews.European respiratory review : an official journal of the European Respiratory Society · 2019Pooled it
- Article
- Decentralising drug-resistant TB treatment initiation services.IJTLD open · 2025Article
- Care-seeking and treatment pathways of multidrug-resistant tuberculosis patients: an analysis of real-world data from regional health information system in Ningbo City in Eastern China.Annals of medicine · 2025Article
- Longitudinal phenotypic and genomic evidence revealing increased risk of drug resistance accumulation in tuberculosis patients in the counties of central China.Microbiology spectrum · 2025Article
- The effects of decentralisation on patient and service outcomes: a case of the 2018 decentralisation of multidrug-resistant tuberculosis in Zambia.Archives of public health = Archives belges de sante publique · 2025Article
- Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho.Global health action · 2024Article
- Self-driven solutions and resilience adapted by people with drug-resistant tuberculosis and their caregivers in Bengaluru and Hyderabad, India: a qualitative study.The Lancet regional health. Southeast Asia · 2024Article
- Finding the missing many: improving Tuberculosis care in Kajiado county through active case finding and community approaches.BMC public health · 2024Article
- Opinion review of drug resistant tuberculosis in West Africa: tackling the challenges for effective control.Frontiers in public health · 2024Review
- Article
- How We Treat Drug-Susceptible Pulmonary Tuberculosis: A Practical Guide for Clinicians.Antibiotics (Basel, Switzerland) · 2023Review
- What clinic closure reveals about care for drug-resistant TB: a qualitative study.BMC infectious diseases · 2023Article
- Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient's perspective.BMC public health · 2023Article
- Cost of treatment support for multidrug-resistant tuberculosis using patient-centred approaches in Ethiopia: a model-based method.Infectious diseases of poverty · 2023Article
- Public health benefits of shifting from hospital-focused to ambulatory TB care in Eastern Europe: Optimising TB investments in Belarus, the Republic of Moldova, and Romania.PLOS global public health · 2023Article
- Tuberculosis care models for children and adolescents: a scoping review.Bulletin of the World Health Organization · 2022Article
- Characteristics of Drug-sensitive and Drug-resistant Tuberculosis Cases among Adults at Tuberculosis Referral Hospitals in Indonesia.The American journal of tropical medicine and hygiene · 2022Article
- Cost of TB services: approach and summary findings of a multi-country study (Value TB).The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
objectiveTo assess the effectiveness of decentralized treatment and care for patients with multidrug-resistant (MDR) tuberculosis, in comparison with centralized approaches.
methodsWe searched ClinicalTrials.gov, the Cochrane library, Embase®, Google Scholar, LILACS, PubMed®, Web of Science and the World Health Organization's portal of clinical trials for studies reporting treatment outcomes for decentralized and centralized care of MDR tuberculosis. The primary outcome was treatment success. When possible, we also evaluated, death, loss to follow-up, treatment adherence and health-system costs. To obtain pooled relative risk (RR) estimates, we performed random-effects meta-analyses.
findingsEight studies met the eligibility criteria for review inclusion. Six cohort studies, with 4026 participants in total, reported on treatment outcomes. The pooled RR estimate for decentralized versus centralized care for treatment success was 1.13 (95% CI: 1.01-1.27). The corresponding estimate for loss to follow-up was RR: 0.66 (95% CI: 0.38-1.13), for death RR: 1.01 (95% CI: 0.67-1.52) and for treatment failure was RR: 1.07 (95% CI: 0.48-2.40). Two of three studies evaluating health-care costs reported lower costs for the decentralized models of care than for the centralized models.
conclusionTreatment success was more likely among patients with MDR tuberculosis treated using a decentralized approach. Further studies are required to explore the effectiveness of decentralized MDR tuberculosis care in a range of different settings.
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Registered trials
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.