A novel approach to directly observed therapy for tuberculosis in an HIV-endemic area.
OBJECTIVE
This study evaluated a novel approach to the delivery of directly observed therapy (DOT) for tuberculosis in Haiti.


METHODS
A total of 194 patients (152 HIV seropositive, 42 HIV seronegative) received daily unsupervised triple-drug therapy for 4 to 8 weeks, followed by twice-weekly 2-drug therapy for the remainder of the 6-month period. DOT was deferred until initiation of the twice-weekly phase.


RESULTS
A total of 169 of 194 patients (87.1%) completed the 6-month course. The program of deferred DOT had an effectiveness of 85%. Overall cost was reduced by approximately 40%.


CONCLUSIONS
Flexible approaches to DOT, integrating behavioral knowledge, cost considerations, and practicality may improve completion rates and program effectiveness.
Desvarieux
M
M
Division of Epidemiology, School of Public Health, Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, USA. desvarieux@epi.umn.edu
Hyppolite
P R
PR
Johnson
W D
WD
Pape
J W
JW
D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage* / Q000191:economics; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D019353:Endemic Diseases; D015658:HIV Infections / Q000453:epidemiology; D006679:HIV Seropositivity; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D015397:Program Evaluation; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology
D000995:Antitubercular Agents