[Directly observed therapy using home-based supervisors for treating tuberculosis in Vitória, Brazil].
OBJECTIVE
To evaluate the use of family members as supervisors of directly observed therapy (DOT) in patients with tuberculosis.


METHODS
This was a prospective descriptive study involving patients diagnosed with pulmonary tuberculosis. The sample comprised 98 patients. A standardized protocol was implemented in order to train the patient and their families. After the training, the patient was allowed to choose either a family member or a health care worker as a supervisor. Absolute and relative frequencies were used in descriptive data analysis.


RESULTS
A family member supervisor was chosen by 94 patients (96%). The cure rate was 99%. The partner was chosen by 49% of the patients, and other family members were chosen by 28%. The heath care team needed to take over DOT in 3% of the cases. Regular attendance at follow-up appointments was 67%. It was observed that 24% of the problems in this DOT model referred to the family supervisor forgetting to administer the medication or to the patient forgetting to take it; 39% of the patients forgot to take the medication for one day, and 31% forgot to take it for two days. There was change of supervisor in 9% of the sample, medication was lost by the patient sometime during treatment in 9%, and patient drug intolerance occurred in 8%.


CONCLUSIONS
DOT supervised by a family member has proven an effective and low-cost technique. However, compliance is not due to one single factor but to the combination of strategies adopted: bus passes; educational measures and especially the individualized approach.
Maciel
Ethel Leonor Noia
EL
Centro de Pesquisa Clínica, Hospital Universitário Cassiano Antônio de Moraes, Vitória, ES, Brasil. emaciel@ndi.ufes.br
Silva
Ana Paula
AP
Meireles
Waleska
W
Fiorotti
Karina
K
Hadad
David Jamil
DJ
Dietze
Reynaldo
R
D000293:Adolescent; D000328:Adult; D001938:Brazil; D017028:Caregivers / Q000523:psychology; D023801:Directly Observed Therapy / Q000379:methods*; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010349:Patient Compliance / Q000523:psychology; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014397:Tuberculosis, Pulmonary / Q000628:therapy*; D055815:Young Adult