Drug-resistant tuberculosis treatment

DOT provider. RCTs (118, 120–122) and observational studies (126, 129, 131, 136, 139, 144, 146, 147, 
149, 150, 154, 155) were available for examination of the effect of DOT providers versus SAT. Providers 
were grouped as health care workers, lay providers and family members. The health care worker 
group was varied and included personnel working at different levels of health care systems and who 
had received health training. Health care workers could be nurses, physicians or trained community 
health workers. Lay providers were also varied and could include teachers, community volunteers 
or traditional healers. DOT by lay providers had higher rates of treatment success and cure, and 
a slightly lower rate of loss to follow-up compared with SAT. Patients receiving DOT from a family 
member had higher rates of treatment success and lower rates of loss to follow-up compared with 
patients using SAT. When DOT provided by a health care worker was compared to SAT, there were 
higher rates of cure and adherence, and lower rates of relapse and acquisition of drug resistance with 
health care worker DOT. The effect that different types of DOT provider had on outcomes was also 
examined. DOT provided by health care workers and DOT provided by lay persons were compared. 
Only observational studies were available in the literature (126, 129, 146, 156–160). Slightly higher rates 
of success, and lower rates of mortality, failure and loss to follow-up were observed among patients 
who had DOT administered by a lay provider versus a health care worker, although the difference 
was not statistically significant. Based on an assessment of the certainty of the evidence, carried out 
using predefined criteria and documented in GRADEpro, the certainty of the evidence was rated as 
very low to high depending on the outcome being assessed and type of
study.

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WHO consolidated 
guidelines 
on
tuberculosis: 
drug-resistant tuberculosis treatment
65
When provision of DOT by a family member was compared to provision of DOT by a health care 
worker, there were higher rates of mortality, loss to follow-up and failure, and lower rates of successful 
treatment, cure and treatment adherence among patients who had DOT administered by family 
members. Therefore, although DOT by a health care worker, trained lay provider and family member 
showed advantages compared to SAT, provision by trained lay providers and health care workers are 
the preferred options for DOT and a family member is the least preferred DOT
provider.