Educational strategy intervention and remote supervision on the post-discharge management of tuberculosis diagnosed in the hospital: Randomized clinical trial.

Introduction: One of the most serious problems in TB control is non-adherence to treatment leading to the risk of drug resistance and subsequent treatment failure.

Objectives: To assess the impact of an educational strategy intervention and remote supervision on the post-discharge management of new cases of TB diagnosed in hospital on TB cure rate. Secondarily, to assess the impact of this intervention on default rate.

Methods: Randomized control trial conducted at a general, tertiary care, university affiliated hospital. New cases of TB diagnosed in hospital were included. The primary outcome was cure rate and secondary outcome was default rate. Analysis was carried out by modified intention to treat.

Results: A total of 169 new tuberculosis patients were enrolled. Among them, 80 were assigned to intervention group and 89 to control group. The cure rate was 71.3% in the intervention group and 58.4% in the control group. In the multivariate binary logistic regression model to evaluate the effect of the intervention, controlled by age, sex, current smoking status and directly observed treatment short, intervention was independently associated with cure rate (OR = 0.47; 95% CI: 0.24-0.94; P = 0.033).There was a significant difference in the default rate between the control and intervention groups (18.0% vs 5.0%, respectively, P = 0.039).

Conclusion: An educational strategy intervention and remote supervision on the post-discharge management of new cases of TB with in-hospital diagnosis had a positive effect of small magnitude on cure rate. Secondarily, the treatment default rate has been significantly decreased with the intervention.