title: Directly observed therapy for tuberculosis in rural South Africa, 1991 through 1994.
abstract: OBJECTIVE
  This paper describes an audit of a community-based tuberculosis treatment program involving directly observed therapy in South Africa.
  
  
  METHODS
  A program audit of 2473 consecutive tuberculosis patients in Hlabisa Health District, KwaZulu/Natal, South Africa, was conducted between 1991 and 1994.
  
  
  RESULTS
  Monthly admissions increased from 34 per month in 1991 to 66 in 1994. Of 2186 patients managed in Hlabisa, 1903 (87%) received directly observed therapy. Of those receiving directly observed therapy, 1034 (55%) were supervised by volunteers; 743 (72%) of these were supervised by storekeepers. Among those patients managed locally, 1679 (85%) of 1967 surviving patients completed treatment. Completion rates for patients supervised by health workers and non-health workers were the same. Completion fell from a high of 90% in 1992 to 78% in 1994. Mortality increased from 5% in 1991 to 10% in 1994.
  
  
  CONCLUSIONS
  Community-based directly observed therapy that uses an intermittent drug regime and volunteers as supervisors can achieve high treatment completion rates for tuberculosis, even in resource-poor settings.
authors.affiliation: Centre for Epidemiological Research, South African Medical Research Council, Hlabisa, South Africa.
authors.forename: D
authors.initials: D
authors.lastname: Wilkinson
authors.forename: G R
authors.initials: GR
authors.lastname: Davies
authors.forename: C
authors.initials: C
authors.lastname: Connolly
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration*; D006801:Humans; D008485:Medical Audit; D010343:Patient Admission / Q000639:trends; D010349:Patient Compliance; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology / Q000517:prevention & control*; D014838:Volunteers
chemical_list: D000995:Antitubercular Agents