title: The Baltimore City Health Department program of directly observed therapy for tuberculosis.
abstract: To address the vexing problem of treatment completion for tuberculosis patients, the Baltimore City Health Department (BCHD) in 1981 implemented a community outreach strategy employing directly observed therapy (DOT). By 1995, the incidence of tuberculosis in Baltimore had declined 61.7%. This BCHD program has reduced the need for patient incentives by providing nearly 90% of all DOT at either the patient's home, workplace or school; or drug treatment facility, city jail, or nursing home. Today, the proportion of all TB cases in Baltimore receiving DOT through the program approaches 90%, treatment completion rates exceed 90%, sputum-conversion rates among DOT-managed cases are nearly double the rates of privately treated cases, and drug resistant organisms remain rare (0.57% of all isolates, 1989-1993). This article describes the interworkings of this community-based program.
authors.affiliation: Eastern Chest Clinic, Baltimore City Health Department, Maryland, USA.
authors.forename: C P
authors.initials: CP
authors.lastname: Chaulk
authors.forename: D S
authors.initials: DS
authors.lastname: Pope
mesh_terms: D015142:Baltimore / Q000453:epidemiology; D019090:Case Management; D003140:Communicable Disease Control; D003153:Community Health Services; D018563:Disease Notification; D006801:Humans; D010349:Patient Compliance; D018579:Patient Selection; D011159:Population Surveillance; D011786:Quality Control; D012041:Regional Medical Programs / Q000458:organization & administration; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control