Directly observed treatment for tuberculosis in pharmacies compared with self-administered therapy in Spain.
OBJECTIVE
To compare directly observed treatment (DOT) of tuberculosis through pharmacy offices with self-administered treatment (SAT) in patients at risk for non-adherence.


METHODS
Prospective study for DOT (1999-2002) and retrospective study for SAT (1996-1998) in patients at risk for non-adherence (human immunodeficiency virus [HIV] infection, alcoholism, illicit drug use, immigrant or homeless status and/or previous failure to complete). Patients in the DOT programme received medication as out-patients twice a week in pharmacies that supervised adherence and provided socio-sanitary support to patients.


RESULTS
There were 101 and 112 patients in the DOT and SAT groups, respectively. Demographic and clinical characteristics were similar in both groups. Differences were observed in risk factors for non-adherence (more immigrants and fewer intravenous drug users in the DOT vs. the SAT groups; P < 0.05). In the DOT group, 76 patients (75.2%) completed treatment and were cured compared to only 30 patients (26.7%) in the SAT group (P < 0.001). Implementation of DOT increased the cost of treatment by 400 Euro per patient compared to SAT.


CONCLUSIONS
In patients at risk for non-adherence, DOT implemented through pharmacy offices was better than SAT; however, completion rates were still low.
Juan
G
G
Department of Medicine, Faculty of Medicine, University of Valencia, Spain. Gustavo.Juan@uv.es
Lloret
T
T
Perez
C
C
Lopez
P
P
Navarro
R
R
Ramón
M
M
Cortijo
J
J
Morcillo
E J
EJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D023801:Directly Observed Therapy / Q000379:methods*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010594:Pharmacies / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012189:Retrospective Studies; D012646:Self Administration / Q000706:statistics & numerical data; D013030:Spain; D014376:Tuberculosis / Q000188:drug therapy*
D000995:Antitubercular Agents