Background: This quasi-experimental cohort study aimed to evaluate World Health Organization (WHO) defined tuberculosis (TB) treatment outcomes for Patients under directly observed treatment at a health facility (clinic DOT) or at home (family DOT) in urban Pakistan. Methods: We enrolled 582 sputum smear-positive TB Patients being treated by either clinic DOT (n = 295) or family DOT (n = 287) in 11 treatment centres. Patients and/or family members were interviewed for baseline measurements. WHO-defined treatment outcomes were evaluated at the end of treatment. Proportions of \u27cured\u27 Patients were computed. A log-binomial model was used to evaluate the associations of various factors with \u27cured\u27 status. Results: The proportion of \u27cured\u27 Patients was respectively 66% and 34% in the clinic DOT and family DOT groups (risk difference 0.32, 95%CI 0.24-0.39). Patients on clinic DOT were more likely to achieve cure (adjusted relative risk [RR(adj)] 1.85, 95%CI 1.43-2.39) than those on family DOT, as were Patients satisfied with their health care worker\u27s attitude (RR(adj) 5.73, 95%CI 2.54-12.96). Conclusion: Clinic DOT nearly doubled the proportion of cured Patients compared to family DOT. Efforts to improve care-provider attitudes to enhance Patient satisfaction, and effective implementation of the WHO\u27s public-private mix approach, may enhance TB control in this and similar settings
