Treatment of tuberculosis in a rural area of Haiti: directly observed and non-observed regimens. The experience of H pital Albert Schweitzer.
METHODS
Artibonite Valley, a rural area in Haiti.


OBJECTIVE
To evaluate a tuberculosis control program in rural Haiti and to compare two strategies for treatment implemented in two areas that were not chosen at random: treatment delivered at the patients' homes observed by former tuberculosis patients (DOT), and non observed treatment (non-DOT).


METHODS
Retrospective analysis of the clinical records of adult patients diagnosed with tuberculosis at H pital Albert Schweitzer in Deschapelles, Haiti, during 1994-1995.


RESULTS
There were 143 patients in the non-DOT group and 138 patients in the DOT group. The results of treatment were significantly different: in the non-DOT group 29% defaulted, 12% died and 58% had a successful outcome; in the DOT group 7% defaulted (P < 0.01), 4% died (P = 0.01) and 87% had a successful outcome (P < 0.01). These differences are also significant when considering only human immunodeficiency virus (HIV) infected patients (defaulted P < 0.01; died P = 0.09; successful outcome P < 0.01).


CONCLUSIONS
Delivering treatment in patients' homes with direct observation by former tuberculosis patients can achieve good results, even in an area of extreme poverty and high rates of HIV infection. In this population the number of patients who are able to complete their treatment without observed administration is far from optimal.
Catalan Association for the Prevention and Treatment of Tuberculosis in the Third World (ACTMON) Barcelona, Spain. nicogallego@retemail.es
J E
JE
Ollé-Goig
J
J
Alvarez
D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology; D006205:Haiti / Q000453:epidemiology; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D019370:Observation; D017063:Outcome Assessment, Health Care; D010349:Patient Compliance; D012189:Retrospective Studies; D019035:Rural Health Services; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology
D000995:Antitubercular Agents