Community-Based Isolation Versus Facility-Based Care for Drug-Resistant Tuberculosis: A Cluster-Randomized Hybrid Effectiveness–Implementation Trial

Abstract

The Drug-resistant tuberculosis presents a major global health challenge, requiring prolonged treatment and complex care delivery models. This study evaluates the comparative effectiveness of community-based isolation and facility-based care using a hybrid effectiveness–implementation trial framework. Evidence suggests that community-based directly observed therapy improves treatment success and reduces adverse events compared to facility-based care . Additionally, decentralized care models reduce patient burden and improve adherence, particularly in low-resource settings . This study integrates clinical outcomes, adherence rates, and implementation feasibility to assess both models. Results indicate that community-based care enhances treatment success, reduces mortality, and improves patient satisfaction, while facility-based care provides better clinical supervision but faces challenges related to accessibility and cost. The findings support a shift toward patient-centered, decentralized care models for DR-TB management. The study highlights the need for integrated health systems that balance clinical oversight with accessibility to optimize treatment outcomes.