***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background One of the main strategies to control tuberculosis ( TB ) is to find and treat people with active disease . Unfortunately , the case detection rates remain low in many countries . Thus , we need interventions to find and treat sufficient number of patients to control TB . We investigated whether involving health extension workers ( HEWs : trained community health workers ) in TB control improved smear-positive case detection and treatment success rates in southern Ethiopia . Methodology /Principal Finding We carried out a community-r and omized trial in southern Ethiopia from September 2006 to April 2008 . Fifty-one kebeles ( with a total population of 296 , 811 ) were r and omly allocated to intervention and control groups . We trained HEWs in the intervention kebeles on how to identify suspects , collect sputum , and provide directly observed treatment . The HEWs in the intervention kebeles advised people with productive cough of 2 weeks or more duration to attend the health posts . Two hundred and thirty smear-positive patients were identified from the intervention and 88 patients from the control kebeles . The mean case detection rate was higher in the intervention than in the control kebeles ( 122.2 % vs 69.4 % , p<0.001 ) . In addition , more females patients were identified in the intervention kebeles ( 149.0 vs 91.6 , p<0.001 ) . The mean treatment success rate was higher in the intervention than in the control kebeles ( 89.3 % vs 83.1 % , p = 0.012 ) and more for females patients ( 89.8 % vs 81.3 % , p = 0.05 ) . Conclusions / Significance The involvement of HEWs in sputum collection and treatment improved smear-positive case detection and treatment success rate , possibly because of an improved service access . This could be applied in setting s with low health service coverage and a shortage of health workers . Trial Registration Clinical Trials.gov A r and omized controlled trial was carried out in Pakistan in 1999 to establish the effectiveness of the direct observation component of DOTS programmes . It found no significant differences in cure rates for patients directly observed by health facility workers , community health workers or by family members , as compared with the  control group who had self-administered treatment .  This paper reports on the social studies which were carried out during and after this trial , to explain these results . They consisted of a survey of all patients ( 64 % response rate ) ; in-depth interviews with a smaller sample of different types of patients ; and focus group discussion s with patients and providers . One finding was that of the 32 in-depth interview patients , 13 ( mainly from the health facility observation group ) failed to comply with their allocated DOT approach during the trial , citing the inconvenience of the method of observation . Another finding was that while patients found the overall TB care approach efficient and economical in general , they faced numerous barriers to regular attendance for the direct observation of drug-taking ( most especially , time , travel costs , ill health and need to pursue their occupation ) . This may be one of the reasons why there was no overall benefit from direct observation in the trial . Provider attitudes were also poor : health facility workers expressed cynical and uncaring views ; community health workers were more positive , but still arranged direct observation to suit their , rather than patients ' , schedules . The article concludes that direct observation , if used , should be flexible and convenient , whether at a health facility close to the patient 's home or in the community . The emphasis should shift in practice from tablet watching towards treatment support , together with education and other adherence measures We assessed the effect of community participation on treatment outcomes for tuberculosis patients undergoing directly-observed therapy , short course ( DOTS ) . From February to December 2001 172 newly diagnosed patients in Baghdad were allocated into 2 treatment groups . The intervention group were visited daily at home for the 2-month initial phase by trained members of the Iraqi Women 's Federation while the control group attended the local health centre for treatment .  Cure rates for patients treated at home were significantly better than controls ( 83.7 % versus 68.6 % ) , so too was compliance ( 100.0 % versus 14.0 % ) . Smear conversion rates were significantly better in intervention cases compared with controls at all stages . Default rates were similar in both groups ( 11.6 % versus 10.5 % ) , as was mortality ( 1 patient each ) SETTING Two small urban townships ( compounds ) in Ndola , Zambia , served by an HIV/AIDS home care programme . OBJECTIVE To evaluate the implementation of the directly observed treatment , short-course ( DOTS ) strategy as part of an existing HIV/AIDS home care programme , by comparing TB treatment outcomes in an intervention population ( Chipulukusu compound ) , where implementation of the DOTS strategy is an integral part of the HIV/AIDS home care programme , and in a control population ( Twapia compound ) with district TB services but as yet without coverage by the HIV/AIDS home care programme . DESIGN Prospect i ve evaluation of all new sputum smear-positive TB patients registered in Chipulukusu and Twapia compounds between 1 February 1998 and 30 September 1999 , with documentation of 2-month sputum smear conversion and 8-month treatment outcomes . RESULTS There were 72 new sputum smear-positive pulmonary TB cases in Chipulukusu and 96 in Twapia registered during the study period . In comparing treatment outcomes in Chipulukusu and Twapia , there was no significant difference in treatment success ( cure plus treatment completion ) ( 61 % vs. 48.9 % ) or in deaths ( 22 % vs. 19 % ) . However , cure rate was significantly higher in Chipulukusu than in Twapia ( 54.2 % vs. 20.8 % ) and treatment interruption was significantly lower in Chipulukusu than in Twapia ( 8.3 % vs. 22.9 % ) . CONCLUSION Integration of the DOTS strategy for TB control with an existing HIV/AIDS home care programme led to improved TB programme performance in a compound with a small population ( about 20000 ) . There is scope to scale up this approach so that the entire population of all the compounds in Ndola served by the HIV/AIDS home care programme can benefit from improved TB control While directly observed treatment ( DOT ) has been recommended as the st and ard approach to tuberculosis control , empirical data on its feasibility and efficiency are still scarce . We conducted a controlled trial of DOT at 15 health care facilities at various levels of the government health care system in Thail and . A total of 836 patients diagnosed between August 1996 and October 1997 were r and omly assigned to be treated either under DOT or self-supervised using monthly drug supplies ( SS ) .  Options for treatment supervisors were health staff , community members or members of the patients ' families . Treatment outcomes were compared on the basis of cure , treatment-completion , default and death rates . In both study arms , treatment outcomes were improved compared to pre- study conditions . Cure and treatment-completion rates were significantly higher in the DOT cohort ( 76 % and 84 % ) than in the SS group ( 67 % and 76 % ) . The benefits of DOT were more pronounced at district and provincial hospitals ( DOT cure rate 81 % vs. 69 % in the SS group ) , while differences for patients treated at referral centres were non-significant ( DOT cure rate 72 % vs. 66 % in the SS group ) . No significant differences in outcomes could be observed between patient groups receiving DOT under the various options for treatment supervisors . DOT appears especially suited for treatment at de central ized facilities . While a general focus on programme performance can improve outcomes , DOT provides significant additional benefits . If basic conditions are met , a DOT strategy can be tailored to country-specific conditions by exploring multiple observation options , without decreasing its effectiveness Background Directly observed therapy ( DOT ) remains the cornerstone of the global tuberculosis ( TB ) control strategy . Tanzania , one of the 22 high-burden countries regarding TB , changed the first-line treatment regimen to contain rifampicin-containing fixed-dose combination for the full 6 months of treatment . As daily health facility-based DOT for this long period is not feasible for the patient , nor for the health system , Tanzania introduced patient centred treatment ( PCT ) . PCT allows patients to choose for daily DOT at a health facility or at their home by a supporter of choice . The introduction of fixed dose combinations in the intensive and continuation phase made PCT feasible by eliminating the risk of selective drug taking by patients and reducing the number of tablets to be taken . The approach was tested in three districts with the objective to assess the effect of this strategy on TB treatment outcomes Methods Cohort analysis comparing patients treated under the PCT strategy ( registered April-September 2006 ) with patients treated under health-facility-based DOT ( registered April-September 2005 ) . The primary outcome was the cure rate . Differences were assessed by calculating the risk ratios . Associations between characteristics of the supporters and treatment outcomes in the group of patients opting for home-based DOT were assessed through logistic regression . Results In the PCT cohort there were 1208 patients and 1417 were included in the historic cohort . There was no significant difference in cure rates between the cohorts ( risk ratio [ RR ] : 1.06 ; 95 % confidence interval [ CI ] : 0.96 - 1.16 ) . In the PCT cohort , significantly more patients had successful treatment ( cure or treatment completed ; RR : 1.10 ; 95%CI : 1.01 - 1.15 ) . There were no characteristics of supporters that were associated with treatment outcome . Conclusion The PCT approach showed similar cure rates and better treatment success rates compared to daily health-facility DOT . The results indicate that there are no specific prerequisites for the supporter chosen by the patient . The programmatic setting of the study lends strong support for scaling-up of TB treatment observation outside the health facility by HEWs in the health posts and general health workers at health facility were compared along a community-r and omized trial . Costs were analysed from societal perspective in 2007 in US $ using st and ard methods . We prospect ively enrolled smear positive patients , and calculated cost-effectiveness as the cost per patient successfully treated . The total cost for each successfully treated smear-positive patient was higher in health facility ( $ 158.9 ) compared with community ( $ 61.7 ) . Community-based treatment reduced the total , patient and caregiver cost by 61.2 % , 68.1 % and 79.8 % , respectively . Involving HEWs added a total cost of $ 8.80 ( 14.3 % of total cost ) on health service per patient treated in the community . Conclusions / Significance Community-based treatment by HEWs costs only 39 % of what treatment by general health workers costs for similar outcomes . Involving HEWs in TB treatment is a cost effective treatment alternative to the health service , to the patients and the family . There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia . However , community-based treatment requires initial investment to start its implementation , training and supervision . Trial Registration Clinical Trials.gov BACKGROUND Tuberculosis remains a major public-health problem in Bangladesh , despite national efforts to improve case identification and treatment compliance . In 1984 , BRAC ( formerly the Bangladesh Rural Advancement Committee ) , a national , non-governmental organisation , began an experimental tuberculosis-control programme in one thana ( subdistrict ) . Community health workers screened villagers for chronic cough and collected sputum sample s for acid-fast bacillus ( AFB ) microscopy ( phase one ) . Positive patients received 12 months of directly observed therapy .  Phase two ( 1992 - 94 ) included another nine thanas and , in phase three ( 1995 ) , eight more thanas were included . From 1995 , the treatment was an 8-month oral regimen . METHODS In 1995 - 96 , we analysed all programme data from 1992 to 1995 . First we analysed phases two ( 12-month therapy ) and three ( 8-month therapy ) separately for proportion cured , died , treatment , failed , defaulted , migrated , and referred . Second , we did a cross-sectional survey of tuberculosis cases in more than 9000 r and omly selected households in two phase-two thanas and one non-programme thana , and analysed the follow-up of all patients treated in the programme thanas . FINDINGS In the phase-two analysis , 3497 ( 90 % ) of 3886 cases identified had accepted 12-month treatment . In phase three , all of 1741 identified cases accepted the 8-month regimen . 2833 ( 81.0 % ) and 1496 ( 85.9 % ) in phases two and three , respectively , were cured ; 336 ( 9.6 % ) and 133 ( 7.6 % ) died . The relapse rate 2 or more years after treatment was discontinued was higher than the early relapse rate . The drop-out rate was 3.1 % . In the cross-sectional survey , the prevalence of tuberculosis in the two programme thanas was half of that in the comparison thana , where only government services were available ( 0.07 vs 0.15 per 100 [ corrected ] ) . INTERPRETATION The BRAC tuberculosis-control programme has successfully achieved high rates of case detection and treatment compliance , with a cure rate of at least 85 % and a drop-out rate of 3.1 % . The prevalence survey suggested that at least half of all existing cases had been detected by the programme SETTING An urban district in Dar es Salaam city with a high tuberculosis ( TB ) caseload . OBJECTIVE To evaluate the effectiveness of community-based direct observation of treatment ( D 
    Output:
    
Conclusions Based on this systematic review , CB DOT has a higher treatment success compared to clinic DOT .