Community- vs. hospital-based management of multidrug-resistant TB in Pakistan

R. Fatima, A. Yaqoob, E. Qadeer, M. A. Khan, A. Ghafoor, B. Jamil, M. U. Haq, N. Ahmed, S. Baig, A. Rehman, Q. Abbasi, A. W. Khan, A. Ikram, J. P. Hicks, J. Walley

Research output: Contribution to journalArticlepeer-review


B A C K G R O U N D: Multidrug-resistant TB (MDR-TB) treatment takes 18–24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care. M E T H O D S: Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged .15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success. R E S U LT S: Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/ 217) under community-based care and 67.8% (141/ 208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI –0.02 to 0.15; P ¼ 0.144). C O N C L U S I O N S: We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.

Original languageEnglish
Pages (from-to)929-933
Number of pages5
JournalInternational Journal of Tuberculosis and Lung Disease
Issue number10
Publication statusPublished - 1 Oct 2022
Externally publishedYes


  • Pakistan
  • ambulatory
  • community-based
  • hospital-based management
  • multidrug-resistant
  • tuberculosis


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