Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil

S. C. Cavalcante, B. Durovni, Grace Link Barnes, F. B A Souza, R. F. Silva, P. F. Barroso, C. I. Mohan, A. Miller, Jonathan E Golub, Richard E Chaisson

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)203-209
Number of pages7
JournalInternational Journal of Tuberculosis and Lung Disease
Volume14
Issue number2
StatePublished - Feb 2010

Fingerprint

Brazil
Tuberculosis
Incidence
Latent Tuberculosis
Pulmonary Tuberculosis
Therapeutics
Infection

Keywords

  • DOTS
  • Household contacts
  • Latent TB infection treatment
  • Tuberculosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Infectious Diseases

Cite this

Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil. / Cavalcante, S. C.; Durovni, B.; Link Barnes, Grace; Souza, F. B A; Silva, R. F.; Barroso, P. F.; Mohan, C. I.; Miller, A.; Golub, Jonathan E; Chaisson, Richard E.

In: International Journal of Tuberculosis and Lung Disease, Vol. 14, No. 2, 02.2010, p. 203-209.

Research output: Contribution to journalArticle

Cavalcante, S. C. ; Durovni, B. ; Link Barnes, Grace ; Souza, F. B A ; Silva, R. F. ; Barroso, P. F. ; Mohan, C. I. ; Miller, A. ; Golub, Jonathan E ; Chaisson, Richard E. / Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil. In: International Journal of Tuberculosis and Lung Disease. 2010 ; Vol. 14, No. 2. pp. 203-209.
@article{6b00fb20e168469ebe98bc70ef2af8cb,
title = "Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil",
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 = "DOTS, Household contacts, Latent TB infection treatment, Tuberculosis",
author = "Cavalcante, {S. C.} and B. Durovni and {Link Barnes}, Grace and Souza, {F. B A} and Silva, {R. F.} and Barroso, {P. F.} and Mohan, {C. I.} and A. Miller and Golub, {Jonathan E} and Chaisson, {Richard E}",
year = "2010",
month = "2",
language = "English (US)",
volume = "14",
pages = "203--209",
journal = "International Journal of Tuberculosis and Lung Disease",
issn = "1027-3719",
publisher = "International Union against Tubercul. and Lung Dis.",
number = "2",

}

TY - JOUR

T1 - Community-randomized trial of enhanced DOTS for tuberculosis control in Rio de Janeiro, Brazil

AU - Cavalcante, S. C.

AU - Durovni, B.

AU - Link Barnes, Grace

AU - Souza, F. B A

AU - Silva, R. F.

AU - Barroso, P. F.

AU - Mohan, C. I.

AU - Miller, A.

AU - Golub, Jonathan E

AU - Chaisson, Richard E

PY - 2010/2

Y1 - 2010/2

N2 - 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.

AB - 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.

KW - DOTS

KW - Household contacts

KW - Latent TB infection treatment

KW - Tuberculosis

UR - http://www.scopus.com/inward/record.url?scp=77049117791&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77049117791&partnerID=8YFLogxK

M3 - Article

C2 - 20074412

AN - SCOPUS:77049117791

VL - 14

SP - 203

EP - 209

JO - International Journal of Tuberculosis and Lung Disease

JF - International Journal of Tuberculosis and Lung Disease

SN - 1027-3719

IS - 2

ER -