***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 
    ***DOCUMENTATION*** 
    ***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 Background Lay health workers ( LHWs ) play a pivotal role in addressing the high TB burden in Malawi . LHWs report lack of training to be a key barrier to their role as TB care providers . Given the cost of traditional off-site training , an alternative approach is needed . Our objective was to evaluate the effectiveness of a KT intervention tailored to LHWs needs . Methods The study design is a pragmatic cluster r and omized trial . The study was embedded within a larger trial , PALMPLUS , and compared three arms which included 28 health centers in Zomba district , Malawi . The control arm included 14 health centers r and omized as controls in the larger trial and maintained as control sites . Seven of 14 PALMPLUS intervention sites were r and omized to the LHW intervention ( PALM/LHW intervention arm ) , and the remaining 7 PALMPLUS sites maintained as a PALM only arm . PALMPLUS intervention sites received an educational outreach program targeting mid-level health workers . LHW intervention sites received both the PALMPLUS intervention and the LHW intervention employing on-site peer-led educational outreach and a point-of-care tool tailored to LHWs identified needs . Control sites received no intervention . The main outcome measure is the proportion of treatment successes . Results Among the 28 sites , there were 178 incident TB cases with 46/80 ( 0.58 ) successes in the control group , 44/68 ( 0.65 ) successes in the PALMPLUS group , and 21/30 ( 0.70 ) successes in the PALM/LHW intervention group . There was no significant effect of the intervention on treatment success in the univariate analysis adjusted for cluster r and omization ( p = 0.578 ) or multivariate analysis controlling for covariates with significant model effects ( p = 0.760 ) . The overall test of the intervention-arm by TB-type interaction approached but did not achieve significance ( p = 0.056 ) , with the interaction significant only in the control arm [ RR of treatment success for pulmonary TB relative to non-pulmonary TB , 1.18 , 95 % CI 1.05–1.31 ] . Conclusions We found no significant treatment effect of our intervention . Given the identified trend for effectiveness and urgent need for low-cost approaches to LHW training , further evaluation of tailored KT strategies as a means of LHW training in Malawi and other LMICs is warranted . Trial registration Clinical Trials.gov NCT01356095 OBJECTIVE To investigate the effects of nutritional supplementation on the outcome and nutritional status of south Indian patients with tuberculosis ( TB ) with and without human immunodeficiency virus ( HIV ) coinfection on anti-tuberculous therapy . METHOD R and omized controlled trial on the effect of a locally prepared cereal-lentil mixture providing 930 kcal and a multivitamin micronutrient supplement during anti-tuberculous therapy in 81 newly diagnosed TB alone and 22 TB-HIV-coinfected patients , among whom 51 received and 52 did not receive the supplement . The primary outcome evaluated at completion of TB therapy was outcome of TB treatment , as classified by the national programme . Secondary outcomes were body composition , compliance and condition on follow-up 1 year after cessation of TB therapy and supplementation . RESULTS There was no significant difference in TB outcomes at the end of treatment , but HIV-TB coinfected individuals had four times greater odds of poor outcome than those with TB alone . Among patients with TB , 1/35 ( 2.9 % ) supplemented and 5/42(12 % ) of those not supplemented had poor outcomes , while among TB-HIV-coinfected individuals , 4/13 ( 31 % ) supplemented and 3/7 ( 42.8 % ) non-supplemented patients had poor outcomes at the end of treatment , and the differences were more marked after 1 year of follow-up . Although there was some trend of benefit for both TB alone and TB-HIV coinfection , the results were not statistically significant at the end of TB treatment , possibly because of limited sample size . CONCLUSION Nutritional supplements in patients are a potentially feasible , low-cost intervention , which could impact patients with TB and TB-HIV . The public health importance of these diseases in re source -limited setting s suggests the need for large , multi-centre r and omized control trials on nutritional supplementation Background Poverty undermines adherence to tuberculosis treatment . Economic support may both encourage and enable patients to complete treatment . In South Africa , which carries a high burden of tuberculosis , such support may improve the currently poor outcomes of patients on tuberculosis treatment . The aim of this study was to test the feasibility and effectiveness of delivering economic support to patients with pulmonary tuberculosis in a high-burden province of South Africa . Methods This was a pragmatic , unblinded , two-arm cluster-r and omized controlled trial , where 20 public sector clinics acted as clusters . Patients with pulmonary tuberculosis in intervention clinics ( n = 2,107 ) were offered a monthly voucher of ZAR120.00 ( approximately US$ 15 ) until the completion of their treatment . Vouchers were redeemed at local shops for foodstuffs . Patients in control clinics ( n = 1,984 )  received usual tuberculosis care . Results Intention to treat analysis showed a small but non-significant improvement in treatment success rates in intervention clinics ( intervention 76.2 % ; control 70.7 % ; risk difference 5.6 % ( 95 % confidence interval : -1.2 % , 12.3 % ) , P = 0.107 ) . Low fidelity to the intervention meant that 36.2 % of eligible patients did not receive a voucher at all , 32.3 % received a voucher for between one and three months and 31.5 % received a voucher for four to eight months of treatment . There was a strong dose – response relationship between frequency of receipt of the voucher and treatment success ( P < 0.001 ) . Conclusions Our pragmatic trial has shown that , in the real world setting of public sector clinics in South Africa , economic support to patients with tuberculosis does not significantly improve outcomes on treatment . However , the low fidelity to the delivery of our voucher meant that a third of eligible patients did not receive it . Among patients in intervention clinics who received the voucher at least once , treatment success rates were significantly improved . Further operational research is needed to explore how best to ensure the consistent and appropriate delivery of such support to those eligible to receive it . Trial registration Current Controlled TrialsIS RCT SETTING Farms in the Bol and health district , Western Cape Province , South Africa . OBJECTIVE To evaluate the effect of lay health workers ( LHWs ) on tuberculosis ( TB ) control among permanent farm workers and farm dwellers in an area with particularly high TB prevalence . DESIGN Pragmatic , unblinded cluster r and omised control trial . METHODS This trial measured successful treatment completion rates among new smear-positive ( NSP ) adult TB patients on 106 intervention farms , and compared them with outcomes in patients on 105 control farms . Farms were the unit of r and omisation , and analysis was by intention to treat . RESULTS A total of 164 adult TB patients were recruited into the study , 89 of whom were NSP .  The successful treatment completion rate in NSP adult TB patients was 18.7 % higher ( P = 0.042 , 95%CI 0.9 - 36.4 ) on farms in the intervention group than on farms in the control group . Case finding for adult NSP TB cases was 8 % higher ( P = 0.2671 ) on farms in the intervention group compared to the control group . CONCLUSION Trained LHWs were able to improve the successful TB treatment rate among adult NSP TB patients in a well-established health service , despite reduction of services Objective To determine the effectiveness of the provision of whole food to enhance completion of treatment for tuberculosis . Design Parallel group r and omised controlled trial . Setting Three primary care clinics in Dili , Timor-Leste . Participants 270 adults aged ≥18 with previously untreated newly diagnosed pulmonary tuberculosis . Main outcome measures Completion of treatment ( including cure ) . Secondary outcomes included adherence to treatment , weight gain , and clearance of sputum smears . Outcomes were assessed remotely , blinded to allocation status . Interventions Participants started st and ard tuberculosis treatment and were r and omly assigned to intervention ( nutritious , culturally appropriate daily meal ( weeks 1 - 8 ) and food package ( weeks 9 - 32 ) ( n=137 ) or control ( nutritional advice , n=133 ) groups . R and omisation sequence was computer generated with allocation concealment by sequentially numbered , opaque , sealed envelopes . Results Most patients with tuberculosis were poor , malnourished men living close to the clinics ; 265/270 ( 98 % ) contributed to the analysis . The intervention had no significant beneficial or harmful impact on the outcome of treatment ( 76 % v 78 % completion , P=0.7 ) or adherence ( 93 % for both groups , P=0.7 ) but did lead to improved weight gain at the end of treatment ( 10.1 % v 7.5 % improvement , P=0.04 ) . Itch was more common in the intervention group ( 21 % v 9 % , P<0.01 ) . In a subgroup analysis of patients with positive results on sputum smears , there were clinical ly important improvements in one month sputum clearance ( 85 % v 67 % , P=0.13 ) and completion of treatment ( 78 % v 68 % , P=0.3 ) . Conclusion Provision of food did not improve outcomes with tuberculosis treatment in these patients in Timor-Leste . Further studies in different setting s and measuring different outcomes are required . Trial registration Clinical Trials NCT0019256 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 4 
    Output:
    
We did not detect effects of SPS  on the outcomes treatment failure and death .
These findings revealed that SPS might improve TB treatment outcomes in lower-middle-income economies or countries with high burden of this disease .