A controlled comparison of directly observed therapy vs self-administered therapy for active tuberculosis in the urban United States.
OBJECTIVE
To compare treatment completion rates at 8 and 12 months after treatment initiation for patients with active TB treated with either directly observed therapy (DOT) or self-administered therapy (SAT).


METHODS
Retrospective comparison study of DOT and SAT concurrent patient cohorts.


METHODS
Urban Tuberculosis Control Program within a Department of Public Health.


METHODS
Three hundred nineteen patients confirmed to have active TB between July 1, 1994, and June 30, 1995, who began outpatient drug therapy.


METHODS
Patients and/or their physicians chose to receive their anti-TB drug therapy by DOT (n=113) or SAT (n=206) and were assessed for treatment completion at prospectively determined times, 8 and 12 months.


RESULTS
Proportions of patients who completed treatment at 8 and 12 months without crossing over to the other group were compared. At 8 months, 52% of DOT and 35% of SAT patients had completed treatment (relative superiority of DOT, 49%; p=0.003). At 12 months, completion rates were 70% for DOT patients and 53% for SAT patients (relative superiority of DOT, 30%; p=0.006).


CONCLUSIONS
In our setting, patients receiving DOT were much more likely to complete treatment earlier than those receiving SAT. Even with DOT, only 52% of patients had completed treatment by 8 months.
Davidson
B L
BL
City of Philadelphia Department of Public Health, Tuberculosis Control Program, Allegheny University of the Health Sciences, PA, USA. brucedavidson@pobox.com
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010352:Patient Dropouts; D010414:Pennsylvania; D012189:Retrospective Studies; D012648:Self Care; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*; D014504:Urban Health