Evaluation of a unified treatment regimen for all new cases of tuberculosis using guardian-based supervision.
METHODS
Ntcheu District, Malawi, using an oral antituberculosis treatment regimen.


OBJECTIVE
To determine whether directly observed treatment (DOT) during the initial phase of treatment supervised either in hospital, at health centres or by guardians in the community, was associated with 1) satisfactory 2-month and 8-month treatment outcomes, and 2) with a reduction of in-patient hospital-bed days.


METHODS
Prospective data collection of all tuberculosis (TB) patients registered between 1 April 1996 and 30 June 1997, with 2-month and 8-month treatment outcomes, sputum smear conversion in smear-positive pulmonary TB patients (PTB) and in-patient hospital-bed days.


RESULTS
Among the 600 new patients, 302 had smear-positive PTB, 150 smear-negative PTB and 148 extrapulmonary TB (EPTB). Eight-month treatment completion was 65% for smear-positive PTB patients, which was significantly higher than in patients with smear-negative PTB (45%) and EPTB (54%), due mainly to high 8-month mortality rates. The site of the intensive phase was determined in 596 patients: 178 (30%) received DOT from guardians, 115 (19%) from a health centre and 303 (51%) in hospital. At 2 months, mortality rates were significantly higher in hospitalised patients. Two-month treatment outcomes (including sputum smear conversion rates in smear-positive PTB patients) were similar between patients receiving DOT at health centres or from guardians. Decentralised DOT resulted in a 25% reduction in hospital-bed days in patients alive at 2 months compared with that predicted using the old regimens.


CONCLUSIONS
Decentralising DOT to health centres and to guardians during the intensive phase is associated with satisfactory treatment outcomes.
Banerjee
A
A
National Tuberculosis Control Programme, Community Health Science Unit, Lilongwe, Malawi.
Harries
A D
AD
Mphasa
N
N
Nyirenda
T E
TE
Veen
J
J
Ringdal
T
T
Van Gorkom
J
J
Salaniponi
F M
FM
D000284:Administration, Oral; D000553:Ambulatory Care / Q000379:methods* / Q000523:psychology; D000995:Antitubercular Agents / Q000627:therapeutic use*; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005190:Family; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008295:Malawi / Q000453:epidemiology; D008499:Medical Records; D019370:Observation / Q000379:methods*; D010349:Patient Compliance / Q000523:psychology; D015397:Program Evaluation; D011446:Prospective Studies; D019035:Rural Health Services; D012646:Self Administration / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology
D000995:Antitubercular Agents