Direct Observational Therapy for the Treatment of Tuberculosis: A Review of Clinical Evidence and Guidelines

Key Message

Three systematic reviews and six randomized controlled trials were identified regarding the clinical evidence for provision of direct observational therapy (DOT) for the treatment of tuberculosis. The evidence suggested that DOT provided by a family member was as effective as DOT provided by non-family members. Evidence regarding the location for the provision of DOT suggested that alternative locations such as at home, at work, or in the community, can be more or similarly effective as DOT provided in health care facilities. The provision of video observational therapy was found to be equally or more effective than DOT. The body of evidence was limited by its heterogeneity and was largely low to moderate in quality Six evidence-based guidelines were identified regarding the use of DOT for the treatment of tuberculosis. Two guidelines provide strong and conditional recommendations, based on low-quality evidence, that DOT should be administered by people trained specifically to provide DOT. One guideline provides a conditional recommendation, based on moderate-quality evidence, to administer DOT in a community setting or at home rather than a health care facility. For the general population, and members of vulnerable or hard-to-reach populations, two guidelines recommend video observational therapy as an alternative to DOT, based on weak evidence.