Improvements in treatment success rates with directly observed therapy in Rio de Janeiro City.
METHODS
Rio de Janeiro City, Brazil.


OBJECTIVE
To evaluate the effect of directly observed therapy (DOT) on treatment success, by comparing the treatment success rates between patients treated under DOT with those who received self-administered therapy (SAT).


METHODS
A longitudinal study in a cohort of tuberculosis (TB) patients. Of 9929 new pulmonary TB cases, 1190 (12%) were treated under DOT and 8739 (88%) under SAT. All patients received a three-drug regimen consisting of rifampicin (RMP), isoniazid (INH) and pyrazinamide for 2 months followed by 4 months of RMP and INH.


RESULTS
Patients under DOT were more likely to convert to sputum-negative at the end of the second month than those treated under SAT (86.3% vs. 61.9%, P < 0.001). DOT alone was significantly associated with successful treatment (OR 1.6, 95%CI 1.37-1.86, P < 0.001), even when controlled by sex, age and positive smear or culture at enrollment (OR 1.56, 95%CI 1.33-1.82, P < 0.001).


CONCLUSIONS
This pilot DOTS implementation phase showed that DOT is highly effective and feasible in a large urban centre of a developing country.
Soares
E C C
EC
Tuberculosis Control Programme, Communicable Diseases Coordination, Health Secretariat of Rio de Janeiro City, Brazil. eccsoares@rio.rj.gov.br
Pacheco
A G F
AG
Mello
F C Q
FC
Durovni
B
B
Chaisson
R E
RE
Cavalcante
S C
SC
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001938:Brazil; D023801:Directly Observed Therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012074:Remission Induction; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000995:Antitubercular Agents