Skip to main content

Table 3 Grading of the body of evidence for effectiveness of DOT versus SAT. Question: Does DOT result in higher initiation, adherence, or completion rates than SAT in individuals eligible for LTBI treatment?

From: Interventions for improving adherence to treatment for latent tuberculosis infection: a systematic review

 

Quality assessment

n/N = %

Effect

Quality

Importance

No of studies (No of participants)

Design

Population treatment intervention

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

DOT

OR (95 % CI)

Absolutea (per 1000 (95 % CI))

SAT

Initiation

0 (0)

No evidence available

–

–

–

–

–

–

–

–

–

–

Critical

Adherence

0 (0)

No evidence available

–

–

–

–

–

–

–

–

–

–

Critical

Completion

1 (199) [17]

RCT

PWIDb long H

Seriousc

Not serious

Not serious

Not serious

None

79/99 = 80 %

1.1 (0.5–2.1)

15 (−137-98)

⊕ ⊕ ⊕O Moderate

Critical

Outreach DOT vs. SAT

79/100 = 79 %

1 (111) [16]

RCT

PWIDb long H

Very seriousd

Not serious

Not serious

Seriouse

None

49/72 = 68 %

14.5 (5.0–42)

552 (296-732)

⊕OOO Very low

Critical

DOT + Methadone treatment vs. SAT + no incentivef

5/39 = 13 %

1 (7731) [20]

RCT

Case contacts

Very seriousg

Not serious

Not serious

Not serious

None

3273/3986 = 82 %

2.1 (1.9–2.3)

134 (119–146)

⊕ ⊕ OO Low

Critical

DOT + 3H + RPT vs. SAT + long H

2585/3745 = 69 %

1 (135) [54]

RCT

Immigrants long H

Serioush

Not serious

Not serious

Seriouse

None

6/82 = 7.3 %

0.1 (0.04–0.3)

−342 (−239- -387)

⊕ ⊕ OO Low

Critical

Clinic-based DOTi vs. SAT dailyc

22/53 = 41 %

  1. Bibliography: Chaisson et al. 2001 [17]; Batki et al. 2002 [16]; Sterling et al. 2011 [20]; Matteelli et al. 2000 [54]
  2. n/N No of individuals with LTBI who initiated, or adhered to or completed treatment/total number of subjects; CI confidence interval; DOT directly observed therapy; H, 3H (3 months) isoniazid; OR odds ratio; PWID people who inject drugs; RCT randomized controlled trial; RPT rifapentine; SAT self-administered therapy
  3. aCalculated via GradePro
  4. bBoth studies with PWID population are presented separately, since one of the studies applies DOT + an incentive as intervention
  5. cChaisson et al. 2001 [17]: unclear allocation concealment; no blinding; use of unvalidated patient-reported outcomes in SAT arm (self-report; urine tests and MEMS in a subset of patients in this study show that self-reported adherence was greatly overestimated, thereby possibly underestimating the effect of DOT)
  6. dBatki et al. 2002 [16]: no blinding; use of unvalidated patient-reported outcomes in SAT arm (monthly medication pick-up); dissimilarities between treatment arms (age, Addiction Severity Index psychiatric and Beck depression inventory); exposure bias (incentive in DOT arm)
  7. etotal number of events <125
  8. fApproximately half of the intervention group (37/72) also received substance abuse counselling
  9. gSterling et al. 2011 [20]: unclear allocation concealment; no blinding; use of unvalidated patient-reported outcomes in SAT arm (pill count and self-report); dissimilarities between treatment arms (with respect to North American Indians, subjects enrolled in a cluster, homelessness); exposure bias (short treatment in DOT arm)
  10. hMatteelli et al. 2000 [54]: unclear allocation concealment; no blinding; very large loss to follow-up; unclear treatment adherence assessment in SAT arm; unequal numbers in treatment arms; early termination (due to low completion rates in DOT arm). Early termination partially accounts for the low numbers in this study, and as we already downgraded for this (serious imprecision), we decided not to downgrade for it again in the risk of bias
  11. iMost likely DOT, however terminology not very clear in the methods and results sections of the article
Back to article page

BMC Infectious Diseases

ISSN: 1471-2334

Contact us