Community DOT for tuberculosis in a Brazilian favela: Comparison with a clinic model

Solange C. Cavalcante, E. C.C. Soares, A. G.F. Pacheco, R. E. Chaisson, B. Durovni, J. Oliveira, J. Pio, Z. Fonseca, J. S. Da Silva E, Gehovânia R. Neves, G. L. Barnes, A. Efron, A. Miller, Bonnie S King, L. Watkinson

Research output: Contribution to journalArticlepeer-review


SETTING: Rio de Janeiro City, Brazil. OBJECTIVE: To compare community-based directly observed treatment (DOT) for tuberculosis (TB), using community health workers (CHWs), with clinic-based DOT. DESIGN: In a longitudinal study in a cohort of TB patients in a region of Rio de Janeiro city, we evaluated treatment modalities and outcomes in 1811 patients diagnosed with TB between 1 January 2003 and 30 December 2004. Patients were offered DOT when they presented to out-patient clinics for an initial diagnosis. DOT was provided in the clinic or in the community, using CHWs, for patients living in a large favela. Outcomes of treatment were assessed using treatment registry databases. RESULTS: Of the 1811 TB patients, 1215 (67%) were treated under DOT; among these, 726 (60%) received clinic-based treatment and 489 (40%) community-based treatment. Patients offered community-based treatment were more likely to accept DOT (99%) than those offered clinic-based treatment (60%, P < 0.001). Treatment success rates for new smear-positive and retreatment TB cases were significantly higher among those treated with community-based DOT compared to clinic-based DOT. CONCLUSION: We conclude that using CHWs to deliver DOT in the community may improve TB treatment outcomes in selected areas such as urban slums.

Original languageEnglish (US)
Pages (from-to)544-549
Number of pages6
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number5
StatePublished - May 2007


  • Community
  • Community health workers
  • DOT
  • Treatment success
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases


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