title: Directly observed therapy and treatment adherence.
abstract: Direct observation of patients taking their medication is a strategy to improve completion rates for tuberculosis treatment, but the programmes to implement this approach consist of a complex array of inputs aimed at influencing adherence. Policy makers need a clear understanding of these inputs to succeed. We systematically identified and reviewed published reports of direct observation therapy (DOT) programmes and compared inputs with WHO's short-course DOT programme. DOT programmes frequently consist of more than the five elements of WHO's strategy, including incentives, tracing of defaulters, legal sanctions, patient-centred approaches, staff motivation, supervision, and additional external funds. Focusing on direct observation as a key factor in the promotion of adherence seems inappropriate. Multiple components might account for the success of DOT programmes, and WHO should make these explicit.
authors.affiliation: South African Cochrane Centre, Medical Research Council, Cape Town, South Africa. jvolmink@mrc.ac.za
authors.forename: J
authors.initials: J
authors.lastname: Volmink
authors.forename: P
authors.initials: P
authors.lastname: Matchaba
authors.forename: P
authors.initials: P
authors.lastname: Garner
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D003140:Communicable Disease Control / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D010348:Patient Care Team / Q000331:legislation & jurisprudence; D010349:Patient Compliance; D015397:Program Evaluation; D014376:Tuberculosis / Q000188:drug therapy*; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents