Drug-resistant tuberculosis treatment

DOT location. RCTs and observational studies examined how DOT location affected treatment 
outcome. Locations were grouped by community- or home-based DOT, and health facility-based DOT 
(118, 120, 121, 124, 131, 136, 144, 146, 149, 150, 161–198). Community- or home-based DOT was defined 
as DOT delivered in the community close to the patient’s home or workplace. In general, community- 
or home-based DOT was provided close to the patients. Health facility-based DOT was defined as DOT 
delivered at a health centre, clinic or hospital. There were some instances of community- or home-
based DOT being provided by health care workers. 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. 
When comparing DOT locations, community- or home-based DOT had higher rates of treatment 
success, cure, treatment completion and 2-month sputum conversion. Community- or home-based 
DOT also had lower rates of mortality and lower rates of unfavourable outcomes compared with 
health facility-based DOT. When comparing community-/ home-based DOT or health facility-based 
DOT with SAT, there were no significant differences across the outcomes in RCTs. However, cohort 
studies showed higher rates of treatment success and adherence, and a lower rate of loss to follow-up 
with community-/home-based DOT compared with SAT. Observational data from cohort studies also 
showed lower rates of treatment completion, and slightly higher rates of failure and loss to follow-up 
in health-facility DOT compared to SAT. Therefore, community- or home-based DOT is the preferred 
option rather than health facility-based DOT and SAT. Combining the evidence on DOT provider and 
DOT location, DOT should preferably be delivered at home or in the community and by a health care 
worker or trained lay provider. DOT delivered at a health facility, DOT provided by a family member 
and unsupervised treatment are not preferred
options.