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2020-06-03
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COMMUNITY-RANDOMIZED TRIAL OF ENHANCED DOTS FOR TUBERCULOSIS CONTROL IN RIO DE JANEIRO, BRAZIL
Cavalcante, S. C. et al. | Date Issued: 2010
Author
Cavalcante, S. C.
Durovni, B.
Barnes, G. L.
Souza, F. B. A.
Silva, R. F.
Barroso, P. F.
Mohan, C. I.
Miller, A.
Golub, J. E.
Chaisson, R. E.
Affilliation
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil / Universidade Federal do Rio de Janeiro. School of Medicine. Hospital Universitário Clementino Fraga Filho. Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Johns Hopkins University. Center for Tuberculosis Research. Departments of Medicine, Epidemiology and International Health. Baltimore, MD, USA.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil / Universidade Federal do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.
Municipal Health Secretariat. Rio de Janeiro, RJ, Brazil.
Universidade Federal do Rio de Janeiro. School of Medicine. Hospital Universitário Clementino Fraga Filho. Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Johns Hopkins University. Center for Tuberculosis Research. Departments of Medicine, Epidemiology and International Health. Baltimore, MD, USA.
Johns Hopkins University. Center for Tuberculosis Research. Departments of Medicine, Epidemiology and International Health. Baltimore, MD, USA.
Johns Hopkins University. Center for Tuberculosis Research. Departments of Medicine, Epidemiology and International Health. Baltimore, MD, USA.
Johns Hopkins University. Center for Tuberculosis Research. Departments of Medicine, Epidemiology and International Health. Baltimore, MD, USA.
Abstract
SETTING: Central Rio de Janeiro, Brazil. OBJECTIVE: To compare the impact of routine DOTS vs. enhanced DOTS (DOTS-Ampliado or DOTS-A) on tuberculosis (TB) incidence. DESIGN: Cluster-randomized trial in eight urban neighborhoods pair-matched by TB incidence and randomly assigned to receive either the DOTS-A or DOTS strategy. DOTS-A added intensive screening of household contacts of active TB cases and provision of treatment to secondary cases and preventive therapy to contacts with latent TB infection (LTBI) to the standard DOTS strategy. The primary endpoint was the TB incidence rates in communities after 5 years of intervention. RESULTS—From November 2000 to December 2004, respectively 339 and 311 pulmonary TB cases were enrolled and 1003 and 960 household were identified in DOTS and DOTS-A communities. Among contacts from DOTS-A communities, 26 (4%) had active TB diagnosed and treated, 429 (61.3%) had LTBI detected and 258 (60.1%) started preventive therapy. TB incidence increased by 5% in DOTS communities and decreased by 10% in DOTS-A communities, for a difference of 15% after 5 years (P = 0.04). CONCLUSION: DOTS-A was associated with a modest reduction in TB incidence and may be an important strategy for reducing the burden of TB.
Keywords
Tuberculosis
DOTS
Household contacts
Latent TB infection treatment
 
Publisher
International Union Against Tuberculosis and Lung Disease
Citation
CAVALCANTE, S. C. et al. Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil. International Journal of Tuberculosis and Lung Disease, v. 14, n. 2, p. 203-209, Feb. 2010.
ISSN
1027-3719